一项多中心回顾性队列研究表明，对于无法切除的转移性结直肠神经内分泌肿瘤患者，姑息性原发肿瘤切除术可能无法带来生存获益。
Palliative primary tumor resection may not offer survival benefits for patients with unresectable metastatic colorectal neuroendocrine neoplasms, one multicenter retrospective cohort study.
机构信息
Department of Colorectal and Anal Surgery, Beijing Erlonglu Hospital, Beijing, 100016, China.
Department of Colorectal Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
出版信息
BMC Surg. 2024 Mar 12;24(1):85. doi: 10.1186/s12893-024-02380-9.
BACKGROUND
The efficacy of palliative primary tumor resection (PTR) in improving prognosis for patients with unresectable metastatic colorectal neuroendocrine neoplasms (NENs) has not been fully explored.
METHODS
We performed one retrospective cohort study and recruited 68 patients with unresectable metastatic colorectal NENs from two Chinese medical centers between 2000 and 2022. All patients were assigned to PTR group and no PTR group. The clinicopathological manifestation data were carefully collected, and the survival outcomes were compared between the two groups using Kaplan-Meier methods. Propensity score matching (PSM) was conducted to minimize confounding bias. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify prognostic factors.
RESULTS
A total of 32 patients received PTR, and the other 36 patients did not. The median progression-free survival (PFS) and overall survival (OS) times were 4 and 22 months in the whole cohort, respectively. For patients who received no PTR, the median OS was 16 months, and the 1-year OS rate and 3-year OS rate were 56.4% and 39.6%, respectively. For patients who received PTR, the median OS was 24 months, and the 1-year OS rate and 3-year OS rate were 67.9% and 34.1%, respectively. However, the Kaplan-Meier survival curves and log-rank test demonstrated no significant survival difference between the two groups (P = 0.963). Moreover, palliative PTR was also not confirmed as a prognostic factor in subsequent univariable and multivariable Cox proportional hazards regression analyses in both the original and matched cohorts. Only histological differentiation was identified as an independent prognostic factor affecting PFS [hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.02-3.41, P = 0.043] and OS [HR = 3.70, 95% CI: 1.09-12.48, P = 0.035] in the original cohort.
CONCLUSIONS
Palliative PTR may not offer survival benefits for patients with unresectable metastatic colorectal NENs.
背景
姑息性原发肿瘤切除术（PTR）在改善不可切除转移性结直肠神经内分泌肿瘤（NENs）患者预后方面的疗效尚未得到充分探索。
方法
我们进行了一项回顾性队列研究，从 2000 年至 2022 年，从两家中国医疗机构招募了 68 例不可切除转移性结直肠 NENs 患者。所有患者被分为 PTR 组和无 PTR 组。仔细收集临床病理表现数据，并采用 Kaplan-Meier 方法比较两组的生存结局。进行倾向评分匹配（PSM）以最小化混杂偏差。进行单变量和多变量 Cox 比例风险回归分析以确定预后因素。
结果
共有 32 例患者接受了 PTR，其余 36 例患者未接受 PTR。全队列的中位无进展生存期（PFS）和总生存期（OS）分别为 4 个月和 22 个月。对于未接受 PTR 的患者，中位 OS 为 16 个月，1 年 OS 率和 3 年 OS 率分别为 56.4%和 39.6%。对于接受 PTR 的患者，中位 OS 为 24 个月，1 年 OS 率和 3 年 OS 率分别为 67.9%和 34.1%。然而，Kaplan-Meier 生存曲线和对数秩检验表明两组之间的生存差异无统计学意义（P=0.963）。此外，姑息性 PTR 在原始和匹配队列的后续单变量和多变量 Cox 比例风险回归分析中也未被确认为预后因素。只有组织学分化被确定为影响 PFS[风险比（HR）=1.86，95%置信区间（CI）：1.02-3.41，P=0.043]和 OS[HR=3.70，95%CI：1.09-12.48，P=0.035]的独立预后因素在原始队列中。
结论
姑息性 PTR 可能无法为不可切除转移性结直肠 NENs 患者带来生存获益。
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