原发性肿瘤位置（结肠右侧或左侧）及切除术对结肠神经内分泌癌肝转移患者生存的影响：一项基于人群的研究

Primary tumor location (right left side of the colon) and resection affect the survival of patients with liver metastases from colonic neuroendocrine carcinoma: a population-based study.

作者信息

Cai Wen, Ge Weiting, Zhang Jiawei, Xie Siyuan, Wu Dehao, Hu Hanguang, Mao Jianshan

机构信息

Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Cancer Institute, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Cancer Center, Zhejiang University, Hangzhou, China.

出版信息

Therap Adv Gastroenterol. 2021 Oct 29;14:17562848211036453. doi: 10.1177/17562848211036453. eCollection 2021.

DOI:10.1177/17562848211036453

PMID:34733354

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8558787/

Abstract

BACKGROUND

Colonic neuroendocrine carcinomas (co-NECs) are heterogeneous and aggressive, especially with regard to metastasis. Whether co-NECs on the right and left sides of the colon have different characteristics from colon adenocarcinoma is unknown.

METHODS

The co-NEC patients were selected from the 2010-2017 Surveillance, Epidemiology, and End Results Program (SEER) database. The right and left sides of the colon were separated by the splenic flexure. Coarsened exact matching (CEM) was performed to adjust for relevant factors before regression models were constructed.

RESULTS

A total of 669 pathologically diagnosed co-NEC patients with sufficient baseline data were identified from the SEER database. A total of 80.72% of the patients had co-NEC that originated from the right side of the colon, and their mean overall survival (mOS) was similar to that of the patients with left-sided co-NECs (right left: 22.30 m 22.55 m). A total of 44.84% of the patients were diagnosed with liver metastasis (46.68% right side 37.98% left side). In patients with liver metastasis, those with right-sided co-NECs had better survival than those with left-sided co-NECs (mOS right left: 15.37 m 9.62 m; adjusted hazard ratio (HR) = 0.69, 95% confidence interval (CI): 0.49-0.98, = 0.035). To further investigate the survival benefits of primary site resection, we separated the patients who had liver metastasis according to the primary site and performed CEM to balance the groups (no patients underwent liver metastasis resection or intervention). The results suggested that primary surgery could benefit patients with both left- and right-sided co-NECs (adjusted HR = 0.50, 95% CI: 0.33-0.77, = 0.001 on the right side; HR = 0.38, 95% CI: 0.16-0.89, = 0.026 on the left side).

CONCLUSIONS

Co-NECs frequently originate on the right side and commonly develop liver metastasis. Right-sided co-NECs are associated with better survival than left-sided co-NECs after liver metastasis has occurred. Primary site resection is associated with prolonged survival in co-NEC patients with liver metastasis, regardless of the side from which the co-NEC has originated.

摘要

背景

结肠神经内分泌癌（co-NECs）具有异质性且侵袭性强，尤其是在转移方面。结肠左右两侧的co-NECs与结肠腺癌相比是否具有不同特征尚不清楚。

方法

从2010 - 2017年监测、流行病学和最终结果计划（SEER）数据库中选取co-NEC患者。结肠的左右两侧以脾曲为界划分。在构建回归模型之前，采用粗化精确匹配（CEM）来调整相关因素。

结果

从SEER数据库中识别出669例具有足够基线数据的经病理诊断的co-NEC患者。共有80.72%的患者co-NEC起源于结肠右侧，其平均总生存期（mOS）与左侧co-NEC患者相似（右侧对左侧：22.30个月对22.55个月）。共有44.84%的患者被诊断为肝转移（右侧46.68%对左侧37.98%）。在肝转移患者中，右侧co-NEC患者的生存期优于左侧co-NEC患者（mOS右侧对左侧：15.37个月对9.62个月；调整后风险比（HR）= 0.69，95%置信区间（CI）：0.49 - 0.98，P = 0.035）。为进一步研究原发部位切除的生存获益，我们根据原发部位对有肝转移的患者进行分组，并进行CEM以平衡各组（无患者接受肝转移切除或干预）。结果表明，原发手术对左右两侧co-NEC患者均有益（右侧调整后HR = 0.50，95% CI：0.33 - 0.77，P = 0.001；左侧HR = 0.38，95% CI：0.16 - 0.89，P = 0.026）。