晚期胃肠道神经内分泌癌患者治疗和生存的相关预测及预后因素分析

Predictive and prognostic factors associated with treatment and survival of patients with advanced gastrointestinal neuroendocrine carcinoma

目的确定晚期胃肠道神经内分泌癌（GI—NEC）预测及预后标志。方法选取2003-2012年15个医疗机构数据库采集的237例GI—NEC患者临床数据，其中196例接受姑息化疗（CT），41例仅接受最佳支持治疗（BSC）。对患者年龄、性别、组织病理学、应答特征和存活率等进行回顾性分析。结果CT治疗组患者中位数生存期为10个月，而BSC治疗组仅为1个月。一线化疗的有效率为30％，且34％患者病情稳定。ROC分析结果显示，肿瘤增值指数（Ki-67）〈55％是与有效率相关的最佳临界值。当Ki-67〈55％时，治疗有效率（16％）较Ki-67≥55％患者低（41％），但前者生存期（15个月）高于后者（11个月），差异有统计学意义（P=0．000）。统计分析结果表明，体能状态（PS）下降、原发性结直肠癌、血小板（Pk）水平和乳酸脱氢酶（LDH）活力升高是患者生存的负性预后因素。结论PS下降、原发性结直肠癌、Plt水平和LDH活力升高是GI-NEC患者生存的重要负性预后因素。及时进行化疗可提高患者生存期。当患者Ki-67〈55％时，铂化疗的有效率降低，但患者生存期延长。

[Objective] To determine the predictive and prognostic factors of advanced gastrointestinal neuroendocrine carcinoma （GI-NEC）. [Methods] GI-NEC related data of 237 patients were collected from 15 institutional databases from 2003 to 2012. Among the 237 patients, 191 patients were treated with chemotherapy （CT） and 41 patients were treated with best supportive care （BSC）. Then a retrospective observational cohort multi-center study was conducted on the data such as age, gender, histopathology, response character and survival rate. [Results] The patients treated with CT had a median survival of 10 months, while that in the BSC treated patients was 1 month. The response rate to first-line CT was 30% and 34% of these patients had stable GI-NEC. According to the analysis of ROC curve, Ki-67 〈 55% was considered as the best cut-off value related with the response rate. In comparison with patients with Ki-67 ≥ 55%, those with Ki-67 〈 55% had a lower response rate （16% vs 41%） and a longer survival （15 months vs 11 months） with significant differences （P〈 0.001）. Statistic results demonstrated that poor performance status, primary colorectal cancer and elevated levels of platelet and LDH in blood were the most important prognostic factors negatively related with survival of GI-NEC patients. [Conclusions] Poor performance status, primary colorectal cancer and elevated levels of platelet and LDH in blood are the most important negative prognostic factors related with survival of GI-NEC patients. An immediate chemotherapy is suggested for GI-NEC patients. Ki-67 〈 55% could lower the response rate but prolong the survival of patients.