Li Zefeng, Ren Hu, Wang Tongbo, Zhang Xiaojie, Zhao Lulu, Sun Chongyuan, Niu Penghui, Guo Chunguang, Chen Yingtai, Zhao Dongbing
Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2022 Jul 14;12:930491. doi: 10.3389/fonc.2022.930491. eCollection 2022.
The prognostic prolongation effect of surgical resection in the management of gastric neuroendocrine carcinoma (GNEC) with distant metastases was still uncertain. The purpose of this study was to investigate the association of primary tumor resection (PTR) with outcomes in patients with stage IV GNEC.
This retrospective study analyzed patients with distant metastatic GNEC diagnosed between 2000 and 2018 and identified using the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into PTR and non-PTR groups. The stabilized inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. Overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method and log-rank test. Cox-regression analyses (uni- and multivariate) were performed to evaluate factors potentially influencing survival.
A total of 126 patients with a median follow-up of 79 months were identified. Forty-four patients underwent PTR and 82 patients did not undergo surgery. After the IPTW approach, PTR improved the OS in patients with stage IV GNEC (median OS 12 vs. 6 months, P = 0.010). The 1- and 3-year OS for patients with or without PTR were 43.8% and 34.5%, and 27.9% and 6.5%, respectively. The median CSS was 12 months for patients undergoing PTR and 6 months for those who did not. The 1 and 3-year CSS for patients with or without PTR were 45.1% and 37.0%, and 27.9% and 6.5%, respectively. In IPTW-adjusted Cox proportional hazards regression analysis, PTR was recognized as an independent factor for improved survival after the occurrence of distant metastatic disease [OS: hazard ratio (HR) = 0.305; 95% confidence interval (CI): 0.196, 0.475; and CSS: HR = 0.278; 95% CI: 0.171, 0.452].
PTR for stage IV GNEC contributes to a better prognosis compared with non-surgery. This study supported the resection of the primary tumor in patients with distant metastatic GNEC.
手术切除对远处转移的胃神经内分泌癌（GNEC）预后的延长作用仍不明确。本研究旨在探讨原发肿瘤切除（PTR）与IV期GNEC患者预后的相关性。
本回顾性研究分析了2000年至2018年间诊断为远处转移GNEC且使用监测、流行病学和最终结果（SEER）数据库识别出的患者。患者分为PTR组和非PTR组。采用稳定的治疗权重逆概率（IPTW）方法以减少选择偏倚。使用Kaplan-Meier法和对数秩检验估计总生存期（OS）和癌症特异性生存期（CSS）。进行Cox回归分析（单因素和多因素）以评估可能影响生存的因素。
共识别出126例患者，中位随访时间为79个月。44例患者接受了PTR，82例患者未接受手术。采用IPTW方法后，PTR改善了IV期GNEC患者的OS（中位OS为12个月对6个月，P = 0.010）。接受或未接受PTR的患者1年和3年OS分别为43.8%和34.5%，以及27.9%和6.5%。接受PTR的患者中位CSS为12个月，未接受PTR的患者为6个月。接受或未接受PTR的患者1年和3年CSS分别为45.1%和37.0%，以及27.9%和6.5%。在IPTW调整的Cox比例风险回归分析中，PTR被认为是远处转移疾病发生后改善生存的独立因素[OS：风险比（HR）= 0.305；95%置信区间（CI）：0.196，0.475；CSS：HR = 0.278；95%CI：0.171，0.452]。
与非手术相比，IV期GNEC的PTR有助于更好的预后。本研究支持对远处转移GNEC患者进行原发肿瘤切除。
