Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, First People's Hospital of Changshu City, Changshu, Jiangsu, China.
Surg Laparosc Endosc Percutan Tech. 2024 Aug 1;34(4):366-375. doi: 10.1097/SLE.0000000000001291.
Controversy surrounds the indications for endoscopic treatment (ET) versus surgery in addressing gastrointestinal neuroendocrine neoplasms (GI-NENs). This paper aims to compare the long-term survival prognosis between ET and surgery for patients with GI-NENs.
A retrospective analysis of GI-NEN patients diagnosed between 2000 and 2020 was conducted using the SEER database. Overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Prognostic factors were assessed through univariate and multivariate Cox regression analyses. Propensity score matching (PSM) was employed to adjust for clinical variables.
This study encompassed 12,016 patients with GI-NENs, with 3732 patients (31.1%) undergoing ET and 8284 patients (68.9%) opting for surgery. The rectum was the most frequent location for ET, while the small bowel was the predominant site for surgery. Both the ET and surgical groups exhibited similar overall survival risk and cancer-specific survival risk before and after matching. No significant differences in the 1-year, 3-year, 5-year, and 10-year OS and CSS rates were observed between the ET and surgery groups after PSM. Nevertheless, subgroup analysis revealed a significantly better CSS in the ET group than the surgery group, particularly in stage I and tumors sized <10mm ( P <0.01). In the colon subgroup, the OS and CSS of the ET group were superior to those of the surgery group ( P <0.05).
Endoscopic treatment and surgery demonstrate comparable long-term survival prognoses for treating GI-NENs. ET emerges as a viable option for patients averse to surgical interventions.
在内镜治疗（ET）与手术治疗胃肠道神经内分泌肿瘤（GI-NENs）的适应证方面存在争议。本文旨在比较 GI-NEN 患者接受 ET 与手术治疗的长期生存预后。
利用 SEER 数据库对 2000 年至 2020 年间诊断的 GI-NEN 患者进行回顾性分析。采用 Kaplan-Meier 法估计总生存（OS）和癌症特异性生存（CSS）。通过单因素和多因素 Cox 回归分析评估预后因素。采用倾向评分匹配（PSM）调整临床变量。
本研究纳入了 12016 例 GI-NEN 患者，其中 3732 例（31.1%）接受 ET，8284 例（68.9%）接受手术治疗。直肠是 ET 的最常见部位，而小肠是手术的主要部位。ET 和手术组在匹配前后的总生存风险和癌症特异性生存风险相似。PSM 后，ET 组和手术组的 1 年、3 年、5 年和 10 年 OS 和 CSS 率无显著差异。然而，亚组分析显示，在 I 期和肿瘤<10mm 的患者中，ET 组的 CSS 显著优于手术组（P<0.01）。在结肠亚组中，ET 组的 OS 和 CSS 优于手术组（P<0.05）。
ET 和手术治疗 GI-NEN 的长期生存预后相当。ET 为不愿接受手术干预的患者提供了一种可行的选择。
