Department of Endoscopy Center, The First People's Hospital of Kunshan, Suzhou, China.
Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
Surg Endosc. 2024 Nov;38(11):6356-6367. doi: 10.1007/s00464-024-11220-z. Epub 2024 Aug 30.
Endoscopic therapy (ET) and surgical resection (SR) are common surgical methods for the treatment of colorectal neuroendocrine tumors (CRNETs). However, for elderly patients, it remains unclear which surgical method yields better long-term outcomes.
Elderly patients ≥ 65 years with CRNETs diagnosed from 2000 to 2020 were identified from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to minimize selection bias. The Kaplan-Meier method and Cox proportional hazards models were utilized to evaluate the effects of diverse demographic and clinical factors on overall survival (OS) and cancer-specific survival (CSS).
A total of 2214 patients were included in the study, with 1417 patients in the ET group and 797 patients in the SR group. After PSM, the ET group outperformed the SR group in terms of OS (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.44-0.70) and CSS (HR 0.21, 95% CI 0.11-0.40). Similarly, the ET group maintained its advantage in mean 1-, 3-, and 5-year OS and CSS rates compared to the SR group (P < 0.001). Multivariate Cox regression analysis identified age, sex, grade, marital status, and treatment modality as independent risk factors affecting OS, while age, sex, marital status, and treatment modality were identified as independent risk factors affecting CSS.
ET offered superior long-term outcomes for elderly patients ≥ 65 years with CRNETs.
内镜治疗（ET）和手术切除（SR）是治疗结直肠神经内分泌肿瘤（CRNET）的常见手术方法。然而，对于老年患者，哪种手术方法能获得更好的长期结果仍不清楚。
从监测、流行病学和最终结果数据库中确定了 2000 年至 2020 年期间诊断为 CRNET 的年龄≥65 岁的老年患者。采用倾向评分匹配（PSM）以最小化选择偏差。Kaplan-Meier 方法和 Cox 比例风险模型用于评估不同的人口统计学和临床因素对总生存（OS）和癌症特异性生存（CSS）的影响。
共有 2214 例患者纳入研究，其中 ET 组 1417 例，SR 组 797 例。PSM 后，ET 组的 OS（风险比 [HR] 0.56，95%置信区间 [CI] 0.44-0.70）和 CSS（HR 0.21，95% CI 0.11-0.40）均优于 SR 组。同样，与 SR 组相比，ET 组在平均 1 年、3 年和 5 年 OS 和 CSS 率方面也保持优势（P<0.001）。多变量 Cox 回归分析确定年龄、性别、分级、婚姻状况和治疗方式是影响 OS 的独立危险因素，而年龄、性别、婚姻状况和治疗方式是影响 CSS 的独立危险因素。
ET 为年龄≥65 岁的 CRNET 老年患者提供了更好的长期结果。
