肿瘤最大径1~2cm直肠神经内分泌肿瘤338例的预后分析

Prognosis analysis of 338 rectal neuroendocrine neoplasms with maximum diameter of 1 cm to 2 cm

目的分析肿瘤最大径1~2 cm直肠神经内分泌肿瘤(r-NEN)的临床特征和预后影响因素,为其术式选择提供理论依据。方法运用美国监测、流行病学与最终结果(SEER)*Stat 8.3.5软件从美国SEER数据库中提取1988年至2015年肿瘤最大径≤2 cm且病理诊断为r-NEN的患者资料。根据治疗术式分为局部切除术组和根治性切除术组。采用t检验、卡方检验比较患者临床病理特征,Kaplan-Meier生存分析和Cox多元回归分析预后影响因素。结果肿瘤最大径<1 cm r-NEN患者1 831例,肿瘤最大径1~2 cm r-NEN患者338例,其肿瘤分级、肿瘤分期、T分期、淋巴结转移、远处转移、手术方式比较差异均有统计学意义(χ^2=7.120、144.728、86.296、133.096、42.842、52.048,P均<0.05),前者预后优于后者(χ^2=11.590,P=0.001)。肿瘤最大径1~2 cm r-NEN患者中局部切除术组279例(82.5%),根治性手术组59例(17.5%)。对不同术式的肿瘤最大径1~2 cm r-NEN患者行倾向性匹配分析得到41对病例,单因素分析显示年龄、肿瘤分级对肿瘤最大径1~2 cm r-NEN患者生存预后有影响(χ^2=6.837、10.852,P=0.009、0.004)。Cox多因素分析显示,年龄是影响肿瘤最大径1~2 cm r-NEN患者预后的独立影响因素[风险比(HR)值为1.110,95%CI 1.040~1.184,P=0.002]。在无淋巴结或远处转移的亚组分析中,年龄(HR值为1.101,95%CI 1.042~1.162,P=0.001)和手术方式(HR值为3.128,95%CI 1.003~9.754,P=0.049)是影响该亚组患者预后的独立影响因素。结论年龄是影响肿瘤最大径1~2 cm r-NEN患者生存预后的独立因素;在肿瘤无淋巴结或远处转移时,年轻、局部切除术患者预后更佳。

Objective To analyze the clinical characteristics and prognostic factors of rectal neuroendocrine neoplasm (r-NEN) with the maximum diameter of 1 cm to 2 cm, and to provide a theoretical evidence for selection of resection method. Methods From 1988 to 2015, the data of patients pathologically diagnosed as r-NEN with the maximum diameter less than 2 cm were selected from American surveillance, epidemiology, and end results (SEER) database with SEER* Stat 8.3.5 software. According to the resection method, the patients were divided into local resection group and radical resection group. T test and chi-square test were performed to compare the clinicopathological features. Kaplan-Meier survival analysis and Cox multivariate analysis were used to analyze the prognostic factors analysis. Results The maximum diameter of tumors of 1 831 patients with r-NEN was less than 1 cm, and that of 338 patients with r-NEN was between 1 cm and 2 cm. There were significant differences between two groups in tumor grade, tumor stage, T stage, lymph node metastasis, distant metastasis and resection method (χ^2=7.120, 144.728, 86.296, 133.096, 42. 842 and 52.048, all P<0.05). The prognosis of the former was better than that of the latter (χ^2=11.590, P=0.001). Among the patients with r-NEN with the maximum diameter of 1 cm to 2 cm, 279 (82.5%) patients received local resection and 59(17.5%) patients underwent radical surgery. Propensity score matching was used to pair the r-NEN patients with the maximum diameter of 1 cm to 2 cm who received different resection methods, and 41 pairs of cases were enrolled. The results of univariate analysis showed that age and tumor grade affected the survival prognosis of patients with r-NEN of the maximum diameter of 1 cm to 2 cm (χ^2=6.837 and 10.852, P=0.009 and 0.004). The results of Cox multivariate analysis indicated that age was an independent prognostic factor of patients with r-NEN of the maximum diameter of 1 cm to 2 cm (hazard ratio (HR)=1.110, 95% confidence interval (CI) 1.040 to 1.184, P=0.002). Analysis of subgroups without lymph nodes or distant metastases demonstrated that age (HR=1.101, 95%CI 1.042 to 1.162, P=0.001) and resection method (HR=3.128, 95%CI 1.003 to 9.754, P=0.049) were the independent factors. Conclusions Age is an independent factor of patients with r-NEN of the maximum diameter of 1 cm to 2 cm. Among the patients without lymph nodes or distant metastasis the younger cases and those with local resection have better prognosis.