Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
Jiangxi Provincial Key Laboratory of Interdisciplinary Science, Nanchang University, Nanchang, 330006, Jiangxi, China.
Surg Endosc. 2023 Jul;37(7):5444-5452. doi: 10.1007/s00464-023-10019-8. Epub 2023 Apr 10.
The optimal treatment modality for T1-2N0M0 duodenal neuroendocrine tumors (DNETs) is still controversial. In this study, long-term survival outcomes were compared between the endoscopic therapy and surgical therapy for T1-2N0M0 DNETs using the Surveillance, Epidemiology, and End Results (SEER) database.
Patients with DNETs from the SEER database were selected from 2004 to 2015. We used the Kaplan-Meier method and log-rank test to compare long-term survival results between the endoscopic therapy and surgical therapy. An analysis of the multivariable Cox proportional hazards model was performed to identify risk factors for patient prognoses. The 1:1 propensity score matching (PSM) was performed to balance baseline data.
A total of 816 patients with DNETs were included, of which 578 patients (70.8%) received endoscopic therapy and 238 patients (29.2%) received surgical therapy. Before the PSM, there was no difference between the two groups of patients with DNETs on long-term survival [5-year OS (86.1% vs. 87.9%, P = 0.45), 10-year OS (72.5% vs. 72.3%, P = 0.45)]. After adjusting covariates, we found endoscopic therapy and surgical therapy groups had comparable risks of overall survival (HR 0.86, 95% CI 0.60-1.23, P = 0.409) and cancer-specific survival (HR 1.68, 95% CI 0.74-3.83, P = 0.214). In the post-PSM analysis, there was no discernible difference between the endoscopic therapy and surgical therapy group.
Our study found that for T1-2N0M0 DNETs patients, whose long-term OS and CSS results were similar for the endoscopic and surgical therapy groups. For these patients, endoscopic resection might be an optimal therapy modality.
T1-2N0M0 十二指肠神经内分泌肿瘤（DNETs）的最佳治疗方式仍存在争议。本研究利用监测、流行病学和最终结果（SEER）数据库，比较 T1-2N0M0 DNETs 内镜治疗与手术治疗的长期生存结局。
本研究从 SEER 数据库中筛选 2004 年至 2015 年期间的 DNETs 患者。采用 Kaplan-Meier 法和对数秩检验比较内镜治疗与手术治疗的长期生存结果。采用多变量 Cox 比例风险模型分析确定患者预后的危险因素。采用 1:1 倾向评分匹配（PSM）平衡基线数据。
共纳入 816 例 DNETs 患者，其中 578 例（70.8%）接受内镜治疗，238 例（29.2%）接受手术治疗。在 PSM 之前，两组 DNETs 患者的长期生存无差异[5 年 OS（86.1% vs. 87.9%，P=0.45），10 年 OS（72.5% vs. 72.3%，P=0.45）]。调整协变量后，我们发现内镜治疗组和手术治疗组的总体生存风险相当（HR 0.86，95%CI 0.60-1.23，P=0.409）和癌症特异性生存（HR 1.68，95%CI 0.74-3.83，P=0.214）。在 PSM 后分析中，内镜治疗组和手术治疗组之间没有明显差异。
本研究发现，对于 T1-2N0M0 DNETs 患者，内镜治疗和手术治疗组的长期 OS 和 CSS 结果相似。对于这些患者，内镜切除术可能是一种最佳的治疗方式。
