Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China.
Technol Cancer Res Treat. 2021 Jan-Dec;20:15330338211055340. doi: 10.1177/15330338211055340.
Gastric neuroendocrine carcinoma (GNEC) is a class of rare histological subtypes in gastric cancer (GC). This retrospective case-control study aimed to explore the clinicopathological features and overall survival (OS) of patients with GNEC.
A large population of GNEC and intestinal-type GC (IGC) patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The 1:1 propensity score matching (PSM) analysis was initiated to adjust the confounders between GNEC and IGC cohorts. Kaplan-Meier (KM) plots with log-rank tests were used to compare the survival differences in GNEC versus IGC. Additionally, Cox proportional hazard regression models were adopted to characterize the prognostic factors relevant to OS of the GNEC patients.
An entity of 4596 patients were collected, including 3943 (85.8%) IGC patients and 653 (14.2%) GNEC patients. The PSM analysis well-balanced all confounders in GNEC versus IGC (all > .05). The KM plots showed that GNEC had significantly superior OS to IGC both before and after PSM analysis. Before PSM, the median OS was 52 (33.6-70.4) months in GNEC versus 32 (29.3-34.7) months in IGC ( = .0015). After PSM, the median OS was 26 (18.3-33.7) months in GNEC versus 21 (17.7-24.3) months in IGC ( = .0039). Stratified analysis indicated that GNEC had superior survivals to IGC in early stage patients and those who received surgery. In Cox regression analysis, age ≥ 60, tumor size > 50 mm, stage II-IV, T2, and N3 were independent risk factors for the GNEC patients (hazard ratio [HR]>1, < .05). By contrast, year 2010 to 2015, female, and surgery were independent protective factors for these patients (HR < 1, < .05).
GNEC has unique clinicopathological features quite different from IGC and may have a superior survival to IGC in early stage patients. The prognostic factors identified here may assist the clinicians to more individually treat these patients.
胃神经内分泌癌（GNEC）是胃癌（GC）中一类罕见的组织学亚型。本回顾性病例对照研究旨在探讨 GNEC 患者的临床病理特征和总生存期（OS）。
从监测、流行病学和最终结果（SEER）数据库中提取大量 GNEC 和肠型 GC（IGC）患者。启动 1:1 倾向评分匹配（PSM）分析以调整 GNEC 和 IGC 队列之间的混杂因素。采用 Kaplan-Meier（KM）图和对数秩检验比较 GNEC 与 IGC 的生存差异。此外，采用 Cox 比例风险回归模型来描述与 GNEC 患者 OS 相关的预后因素。
共收集了 4596 例患者，其中 3943 例（85.8%）为 IGC 患者，653 例（14.2%）为 GNEC 患者。PSM 分析很好地平衡了 GNEC 与 IGC 之间的所有混杂因素（均> .05）。KM 图显示，GNEC 在 PSM 前后的 OS 均明显优于 IGC。在 PSM 之前，GNEC 的中位 OS 为 52（33.6-70.4）个月，IGC 为 32（29.3-34.7）个月（ = .0015）。PSM 后，GNEC 的中位 OS 为 26（18.3-33.7）个月，IGC 为 21（17.7-24.3）个月（ = .0039）。分层分析表明，在早期患者和接受手术的患者中，GNEC 的生存率优于 IGC。在 Cox 回归分析中，年龄≥60 岁、肿瘤大小>50 mm、分期 II-IV、T2 和 N3 是 GNEC 患者的独立危险因素（风险比[HR]>1， < .05）。相比之下，2010 年至 2015 年、女性和手术是这些患者的独立保护因素（HR < 1， < .05）。
GNEC 具有与 IGC 明显不同的临床病理特征，在早期患者中可能具有优于 IGC 的生存率。这里确定的预后因素可能有助于临床医生更个体化地治疗这些患者。
