小肠腺癌患者转移特点和预后分析

Metastatic Characteristics and Prognosis of Small Bowel Adenocarcinoma

背景:小肠腺癌在消化道肿瘤中发病率相对较低,国内外关于其临床病理特征和预后资料的研究较少。目的:探讨小肠腺癌患者的转移特点并分析其预后。方法:选取SEER数据库中于2010年—2016年确诊为小肠腺癌的病例,提取相关信息,分析转移部位、临床病理特征和预后情况,采用Cox比例风险模型行预后影响因素分析。结果:共2489例小肠腺癌患者纳入研究,其中肝转移448例(18.0%),骨转移48例(1.9%),肺转移129例(5.2%),不同转移部位小肠腺癌的临床病理特征有一定差异。有或无肝转移患者发生骨、肺转移的比例无明显差异(P>0.05)。肝、骨、肺转移患者中位总生存期分别为6、4、8个月,均显著短于无相应部位转移者(P<0.05)。原发灶手术可改善无转移和肝转移患者的预后,但对肺、肝+肺转移者的预后无明显影响。多因素分析显示,年龄>66岁、低分化和未分化肿瘤以及淋巴结转移为预后不良的独立危险因素,而已婚和原发灶手术为保护因素。结论:合并转移的小肠腺癌患者预后较差,不同转移特点患者的预后存在差异。肝脏是发生远处转移的重要器官。已婚和行原发灶手术者预后较好,而高龄、低分化、未分化、淋巴结转移与预后不良相关。

Background:The morbidity of small bowel adenocarcinoma(SBA)in gastrointestinal neoplasms is relatively low,and there are few studies focusing on the clinicopathological features and prognostic data of SBA both at home and abroad.Aims:To investigate the metastatic characteristics and prognosis of patients with SBA.Methods:Patients with SBA were identified from the Surveillance,Epidemiology,and End Results(SEER)database from 2010 to 2016.Data on metastatic patterns,clinicopathological features and prognosis were extracted and analyzed,and the prognostic factors were assessed by Cox proportional hazard model.Results:A total of 2489 cases of SBA were identified,of which 448 cases(18.0%)had liver metastasis,48(1.9%)had bone metastasis,and 129(5.2%)had lung metastasis.Different metastatic sites were associated with different clinicopathological parameters.There were no significant differences in bone or lung metastasis between patients with and without liver metastasis(P>0.05).The median overall survival(OS)of patients with liver,bone,and lung metastasis was 6,4,and 8 months,respectively,all were shorter than that of patients without metastasis at corresponding site(P<0.05).Surgical resection of primary tumor improved the OS of patients without metastasis and with liver metastasis,but had no effect on OS of patients with lung or liver plus lung metastases.Multivariate analysis showed that aged more than 66 years,poorly differentiated and undifferentiated tumors,and lymph node metastasis were independent risk factors for poor prognosis,while married and surgical resection of primary tumor were protective factors.Conclusions:SBA patients with metastasis had a poorer OS than those without.Different metastatic characteristics are associated with different prognosis.Liver is an important distant metastatic organ for SBA.For SBA patients,married and surgical resection of primary tumor are beneficial factors,whereas advanced age,poorly differentiated,undifferentiated,and lymph node metastasis are predictors of poor prognosis.