Abdel-Rahman Omar, Pham Truong-Minh, Pokhrel Arun, Ruether Dean, Sawyer Michael B
Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton.
Surveillance and Reporting, Cancer Research and Analytics, Cancer Care Alberta.
Am J Clin Oncol. 2022 May 1;45(5):208-214. doi: 10.1097/COC.0000000000000906. Epub 2022 Apr 6.
The past 2 decades have observed a number of advances in therapeutic approaches to patients with neuroendocrine neoplasms (NENs). This study aims to assess whether survival outcomes have changed among patients with NENs over the past 15 years, in a real-world, population-based study.
We accessed administrative databases within the province of Alberta, Canada, and we reviewed patients with invasive NENs diagnosed 2004 to 2019. Patients were classified according to the year of diagnosis into 3 groups: 2004 to 2008; 2009 to 2013; and 2014 to 2019. Kaplan-Meier survival estimates were used to compare overall survival (OS) according to different baseline characteristics (including the year of diagnosis). Multivariable Cox regression modeling was used to examine factors associated with the risk of death in this cohort.
We included a total of 3431 patients in the study cohort. Using multivariable Cox regression analysis, the following factors were associated with worse survival: older age at diagnosis (hazard ratio [HR]: 3.45; 95% CI [confidence interval]: 2.74-4.35), male sex (HR: 1.38; 95% CI: 1.21-1.56), lung primary site (HR for lung vs. appendicular primary: 1.39; 95% CI: 1.01-1.92), Stage 4 disease (HR: 2.80; 95% CI: 2.38-3.30), South zone of the province (HR for South zone vs. Calgary zone: 1.85; 95% CI: 1.49-2.30), and higher comorbidity index (HR for ≥3 vs. 0: 2.66; 95% CI: 2.19-3.24). Although Kaplan-Meier method showed significant difference in OS according to diagnosis period, multivariable regression model showed that the period of diagnosis did not appear to impact OS (HR for diagnosis period 2004 to 2009 vs. 2014 to 2019: 1.04; 95% CI: 0.89-1.22).
Over the study period (2004 to 2019), patients diagnosed during later periods did not appear to experience better OS compared with patients diagnosed at an earlier time.
在过去20年中，神经内分泌肿瘤（NENs）患者的治疗方法取得了一些进展。本研究旨在通过一项基于人群的真实世界研究，评估过去15年中NENs患者的生存结局是否发生了变化。
我们访问了加拿大艾伯塔省的行政数据库，并回顾了2004年至2019年诊断为侵袭性NENs的患者。根据诊断年份将患者分为3组：2004年至2008年；2009年至2013年；以及2014年至2019年。采用Kaplan-Meier生存估计法，根据不同基线特征（包括诊断年份）比较总生存期（OS）。多变量Cox回归模型用于研究该队列中与死亡风险相关的因素。
我们在研究队列中总共纳入了3431名患者。通过多变量Cox回归分析，以下因素与较差的生存相关：诊断时年龄较大（风险比[HR]：3.45；95%置信区间[CI]：2.74-4.35）、男性（HR：1.38；95%CI：1.21-1.56）、肺部原发部位（肺部与阑尾原发部位的HR：1.39；95%CI：1.01-1.92）、IV期疾病（HR：2.80；95%CI：2.38-3.30）、该省南区（南区与卡尔加里区的HR：1.85；95%CI：1.49-2.30）以及较高的合并症指数（合并症指数≥3与0的HR：2.66；95%CI：2.19-3.24）。尽管Kaplan-Meier方法显示根据诊断时期OS有显著差异，但多变量回归模型显示诊断时期似乎并未影响OS（2004年至2009年与2014年至2019年诊断时期的HR：1.04；95%CI：0.89-1.22）。
在研究期间（2004年至2019年），与早期诊断的患者相比，后期诊断的患者似乎并未有更好的总生存期。
