Zhou Jialin, Wang Cong, Lv Tingcong, Fan Zhe
Department of General Surgery, The Third People's Hospital of Dalian, Dalian Medical University, Dalian, China.
Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, China.
Heliyon. 2024 Aug 30;10(17):e36881. doi: 10.1016/j.heliyon.2024.e36881. eCollection 2024 Sep 15.
The association between small-bowel adenocarcinoma (SBA) tumor size and prognosis is unclear, and we used the Surveillance, Epidemiology, and End Results (SEER) database to assess the prognostic value of SBA tumor size.
Patients with postoperative SBA were selected from the SEER database, and overall survival (OS) and cancer-specific survival (CSS) were used as outcome variables. Tumor size was used as a categorical and continuous variable, respectively, to adjust for confounders and analyze the association between SBA tumor size and prognosis using Cox proportional hazard regression, and the results were visualized using restricted cubic splines (RCS). Spearman correlation coefficient was used to evaluate the statistical correlation between tumor size and tumor invasion depth (T-stage). Kaplan-Meier survival curves were used to estimate OS at different T stages.
When the tumor size was analyzed as a quantitative variable, the adjusted covariate model showed that the HR was 1.008 (P = 0.04) for OS and 1.021 (P = 0.03) for CSS. And regardless of OS or CSS, when the tumor size < 3-4 cm, there was a close linear relationship between tumor size and HR. What's more, in the SEER database, the 5-year survival rates of T1, T2, T3 and T4 patients were 81.8 %, 81.1 %, 66.0 % and 50.9 % (P < 0.001) according to AJCC T-stage. However, in the modified T-stage (mT), these rates were 82.8 %, 70.6 %, 60.7 % and 39.8 % (P < 0.001). When patients within each of the AJCC T stages were stratified by mT stages, significant survival heterogeneity was observed within each of the AJCC T1 to T4 stages(P < 0.001).
When tumor size is used in a quantitative way, tumor size is an independent predictor of poor outcome in patients with SBA. Furthermore, we established a modified T-stage based on tumor size and depth of invasion.
小肠腺癌（SBA）肿瘤大小与预后之间的关联尚不清楚，我们使用监测、流行病学和最终结果（SEER）数据库来评估SBA肿瘤大小的预后价值。
从SEER数据库中选取SBA术后患者，将总生存期（OS）和癌症特异性生存期（CSS）用作结局变量。肿瘤大小分别用作分类变量和连续变量，以调整混杂因素，并使用Cox比例风险回归分析SBA肿瘤大小与预后之间的关联，结果使用受限立方样条（RCS）进行可视化。使用Spearman相关系数评估肿瘤大小与肿瘤浸润深度（T分期）之间的统计相关性。使用Kaplan-Meier生存曲线估计不同T分期的OS。
当将肿瘤大小作为定量变量进行分析时，调整后的协变量模型显示，OS的HR为1.008（P = 0.04），CSS的HR为1.021（P = 0.03）。并且无论OS还是CSS，当肿瘤大小<3 - 4 cm时，肿瘤大小与HR之间存在密切的线性关系。此外，在SEER数据库中，根据美国癌症联合委员会（AJCC）T分期，T1、T2、T3和T4期患者的5年生存率分别为81.8%、81.1%、66.0%和50.9%（P < 0.001）。然而，在改良T分期（mT）中，这些比率分别为82.8%、70.6%、60.7%和39.8%（P < 0.001）。当按mT分期对每个AJCC T分期内的患者进行分层时，在AJCC T1至T4期的每个阶段内均观察到显著的生存异质性（P < 0.001）。
当以定量方式使用肿瘤大小时，肿瘤大小是SBA患者预后不良的独立预测因素。此外，我们基于肿瘤大小和浸润深度建立了改良T分期。
