Hallet Julie, Law Calvin, Singh Simron, Mahar Alyson, Myrehaug Sten, Zuk Victoria, Zhao Haoyu, Chan Wing, Assal Angela, Coburn Natalie
1Faculty of Medicine, University of Toronto, Toronto, Ontario.
2Susan Leslie Clinic for Neuroendocrine Tumors-Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.
J Natl Compr Canc Netw. 2021 Jun 4;19(8):935-944. doi: 10.6004/jnccn.2020.7666.
Although patients with neuroendocrine tumors (NETs) are known to have prolonged overall survival, the contribution of cancer-specific and noncancer deaths is undefined. This study examined cancer-specific and noncancer death after NET diagnosis.
We conducted a population-based retrospective cohort study of adult patients with NETs from 2001 through 2015. Using competing risks methods, we estimated the cumulative incidence of cancer-specific and noncancer death and stratified by primary NET site and metastatic status. Subdistribution hazard models examined prognostic factors.
Among 8,607 included patients, median follow-up was 42 months (interquartile range, 17-82). Risk of cancer-specific death was higher than that of noncancer death, at 27.3% (95% CI, 26.3%-28.4%) and 5.6% (95% CI, 5.1%-6.1%), respectively, at 5 years. Cancer-specific deaths largely exceeded noncancer deaths in synchronous and metachronous metastatic NETs. Patterns varied by primary tumor site, with highest risks of cancer-specific death in bronchopulmonary and pancreatic NETs. For nonmetastatic gastric, small intestine, colonic, and rectal NETs, the risk of noncancer death exceeded that of cancer-specific deaths. Advancing age, higher material deprivation, and metastases were independently associated with higher hazards, and female sex and high comorbidity burden with lower hazards of cancer-specific death.
Among all NETs, the risk of dying of cancer was higher than that of dying of other causes. Heterogeneity exists by primary NET site. Some patients with nonmetastatic NETs are more likely to die of noncancer causes than of cancer causes. This information is important for counseling, decision-making, and design of future trials. Cancer-specific mortality should be included in outcomes when assessing treatment strategies.
尽管已知神经内分泌肿瘤（NETs）患者的总生存期延长，但癌症特异性死亡和非癌症死亡的贡献尚不明确。本研究调查了NET诊断后的癌症特异性死亡和非癌症死亡情况。
我们对2001年至2015年的成年NET患者进行了一项基于人群的回顾性队列研究。使用竞争风险方法，我们估计了癌症特异性死亡和非癌症死亡的累积发生率，并按原发性NET部位和转移状态进行分层。亚分布风险模型研究了预后因素。
在纳入的8607例患者中，中位随访时间为42个月（四分位间距，17 - 82个月）。5年时，癌症特异性死亡风险高于非癌症死亡风险，分别为27.3%（95%CI，26.3% - 28.4%）和5.6%（95%CI，5.1% - 6.1%）。在同步和异时性转移性NET中，癌症特异性死亡大大超过非癌症死亡。模式因原发性肿瘤部位而异，支气管肺和胰腺NET的癌症特异性死亡风险最高。对于非转移性胃、小肠、结肠和直肠NET，非癌症死亡风险超过癌症特异性死亡风险。年龄增长、更高的物质匮乏程度和转移与更高的风险独立相关，而女性性别和高合并症负担与癌症特异性死亡的较低风险相关。
在所有NET中，死于癌症的风险高于死于其他原因的风险。原发性NET部位存在异质性。一些非转移性NET患者死于非癌症原因的可能性高于死于癌症原因的可能性。这些信息对于咨询、决策和未来试验的设计很重要。在评估治疗策略时，结果应包括癌症特异性死亡率。
