Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Chin Med Sci J. 2021 Dec 31;36(4):284-294. doi: 10.24920/003803.
Objective To investigate the impact of prior non-pancreatic cancer on the survival outcomes of patients with localized pancreatic neuroendocrine tumors (PanNETs). Methods We reviewed the Surveillance, Epidemiology, and End Results database and selected patients with localized PanNETs diagnosed between 1973 and 2015. We divided the patients into two groups according to the presence or absence of prior non-pancreatic malignancy. Before and after propensity score matching, we compared the clinicopathological characteristics and studied the overall survival and cancer-specific survival. Results A total of 357 (12.9%) of 2778 patients with localized PanNETs had prior cancer. A total of 1211 cases with only a localized PanNET and 133 cases with a localized PanNET and prior cancer had complete data and met the inclusion criteria of the current study. Patients with prior cancer were associated with advanced age (>65 years, 57.9% prior cancer . 31.0% no prior cancer, <0.001), later year of diagnosis (87.2% . 80.2%, =0.049), a higher proportion of poorly differentiated/undifferentiated grade tumors (4.5% . 1.5%, =0.025), and a higher proportion of no primary site surgery (19.5% . 10.4%, =0.003). Prostate (29.32%), breast (18.05%), other genitourinary and retroperitoneal (16.54%), and gastrointestinal (12.78%) cancers were the most common prior cancer types. Most of the prior cancers (95.49%) were localized and regional, and only 4.51% of the prior cancers were distant. Patients with interval periods between the prior cancer and PanNET of ≤36 months, 36-60 months, 60-120 months, and >120 months accounted for 33.08%, 13.53%, 24.06%, and 29.32% of all cases with prior cancers, respectively. Univariate and multivariate proportional hazards analyses were performed. The presence/absence of prior cancers did not impact survival outcomes of patients with localized PanNETs before and after propensity score matching (PSM). Further subgroups analysis showed that, patients with localized PanNETs and prior distant cancer had worse cancer-specific survival than patients with prior local/regional cancer or patients without prior cancer (<0.001). No significant differences in cancer-specific survival were observed in terms of the different sites of the prior cancers and the different interval periods of prior cancers and PanNETs (<0.05). Conclusions Patients with localized PanNETs and a history of prior cancer had survival outcomes that were comparable to those of patients with no history of prior cancer. Patients with localized PanNETs and prior cancer could be candidates for clinical trials if they satisfy all other conditions; aggressive and potentially curative therapies should be offered to these patients.
探讨非胰腺恶性肿瘤史对局限性胰腺神经内分泌肿瘤（PanNETs）患者生存结局的影响。
我们检索了 Surveillance，Epidemiology，and End Results（SEER）数据库，纳入 1973 年至 2015 年间诊断的局限性 PanNETs 患者。根据是否存在非胰腺恶性肿瘤史，将患者分为两组。在倾向评分匹配前后，我们比较了两组的临床病理特征，并研究了总生存和癌症特异性生存。
2778 例局限性 PanNETs 患者中，357 例（12.9%）有既往癌症史。1211 例仅患有局限性 PanNETs，133 例患有局限性 PanNETs 和既往癌症，且两组均有完整数据并符合本研究的纳入标准。与无既往癌症史的患者相比，有既往癌症史的患者年龄更大（>65 岁，57.9% vs. 31.0%，<0.001）、诊断年份更新（87.2% vs. 80.2%，=0.049）、分化程度更低/未分化肿瘤比例更高（4.5% vs. 1.5%，=0.025）、原发灶手术比例更低（19.5% vs. 10.4%，=0.003）。前列腺癌（29.32%）、乳腺癌（18.05%）、其他泌尿生殖系统和腹膜后肿瘤（16.54%）和胃肠道肿瘤（12.78%）是最常见的既往癌症类型。大多数既往癌症（95.49%）为局限性和区域性，只有 4.51%的既往癌症为远处转移。有<36 个月、36-60 个月、60-120 个月和>120 个月的既往癌症-局限性 PanNET 间隔期的患者分别占所有既往癌症患者的 33.08%、13.53%、24.06%和 29.32%。单因素和多因素比例风险分析显示，在倾向评分匹配前后，局限性 PanNETs 患者的既往癌症史对生存结局无显著影响。进一步的亚组分析显示，与有局部/区域既往癌症或无既往癌症的患者相比，有远处既往癌症的局限性 PanNETs 患者的癌症特异性生存率更差（<0.001）。在不同的既往癌症部位和不同的既往癌症-局限性 PanNET 间隔期方面，癌症特异性生存率无显著差异（<0.05）。
有局限性 PanNETs 病史的患者的生存结局与无病史的患者相当。如果符合所有其他条件，有局限性 PanNETs 和既往癌症的患者可成为临床试验的候选者，应向这些患者提供积极的、潜在可治愈的治疗方法。
