既往癌症对局限性胰腺神经内分泌肿瘤患者的生存结果有影响吗?

Does Prior Cancer Have an Influence on the Survival Outcomes of Patients with Localized Pancreatic Neuroendocrine Tumors?

目的探讨既往非胰腺来源的恶性肿瘤对局限性胰腺神经内分泌肿瘤(PanNET)患者生存结局的影响。方法我们选取美国肿瘤监测、流行病学和生存结果数据库(the Surveillance,Epidemiology,and End Results database,SEERdatabase)中,1973年至2015年期间诊断为局部Pan NET的患者进行研究。根据患者既往是否存在非胰腺恶性肿瘤,我们将患者分为两组。在倾向评分匹配前和匹配后,我们比较了两组患者的临床病理特征,并研究了总体生存率和癌症特异性生存率的独立影响因素。结果在2778例局限性Pan NET患者中,357例(12.9%)既往曾患有癌症。在2778例患者中,数据资料完整的患者有1344例,其中既往无肿瘤病史的患者1211例,合并肿瘤病史的患者133例。分析发现,既往患有癌症与高龄(65岁以上,57.9%既往患有癌症,31.0%既往无癌症,P<0.001)、诊断年份较晚(87.2%比80.2%,P=0.049)、低分化/未分化级别肿瘤比例较高(4.5%比1.5%,P=0.025)和既往肿瘤未手术比例较高(19.5%比10.4%,P=0.003)相关。前列腺癌(29.32%)、乳腺癌(18.05%)、其他泌尿生殖道癌和腹膜后癌(16.54%)以及胃肠道癌(12.78%)是最常见的既往癌症类型。大多数既往癌症(95.49%)为局限性或区域性肿瘤,只有4.51%的患者既往癌症伴远处转移。两个肿瘤发病间隔时间≤36个月、36-60个月、60-120个月和>120个月分别占33.08%、13.53%、24.06%和29.32%。在对两组患者变量进行倾向评分匹配前和匹配后,我们对患者进行了单变量和多变量Cox比例风险分析,结果显示匹配前和匹配后,既往癌症的存在与否并不影响局部Pan NET患者的生存结果。进一步亚组分析显示,既往合并转移癌症的患者Pan NET特异性生存率比既往局部或区域癌症的患者或既往无癌症的患者生存率低。既往癌症的部位和两种肿瘤的间隔期不影响患者的生存率。结论具有既往癌症史的局限性Pan NET患者的生存结果与无既往癌症史的患者相当。如果其他条件相同,则具有既往癌症史的局限性Pan NET患者可以作为临床试验的候选患者。此研究结果支持为此类患者的Pan NET提供更为积极的治疗方法。

Objective To investigate the impact of prior non-pancreatic cancer on the survival outcomes of patients with localized pancreatic neuroendocrine tumors(Pan NETs).Methods We reviewed the Surveillance,Epidemiology,and End Results database and selected patients with localized Pan NETs diagnosed between 1973 and 2015.We divided the patients into two groups according to the presence or absence of prior non-pancreatic malignancy.Before and after propensity score matching,we compared the clinicopathological characteristics and studied the overall survival and cancer-specific survival.Results A total of 357(12.9%)of 2778 patients with localized Pan NETs had prior cancer.A total of 1211 cases with only a localized Pan NET and 133 cases with a localized Pan NET and prior cancer had complete data and met the inclusion criteria of the current study.Patients with prior cancer were associated with advanced age(>65 years,57.9%prior cancer vs.31.0%no prior cancer,P<0.001),later year of diagnosis(87.2%vs.80.2%,P=0.049),a higher proportion of poorly differentiated/undifferentiated grade tumors(4.5%vs.1.5%,P=0.025),and a higher proportion of no primary site surgery(19.5%vs.10.4%,P=0.003).Prostate(29.32%),breast(18.05%),other genitourinary and retroperitoneal(16.54%),and gastrointestinal(12.78%)cancers were the most common prior cancer types.Most of the prior cancers(95.49%)were localized and regional,and only 4.51%of the prior cancers were distant.Patients with interval periods between the prior cancer and Pan NET of≤36 months,36-60 months,60-120 months,and>120 months accounted for 33.08%,13.53%,24.06%,and 29.32%of all cases with prior cancers,respectively.Univariate and multivariate Cox proportional hazards analyses were performed.The presence/absence of prior cancers did not impact survival outcomes of patients with localized Pan NETs before and after propensity score matching(PSM).Further subgroups analysis showed that,patients with localized Pan NETs and prior distant cancer had worse cancer-specific survival than patients with prior local/regional cancer or patients without prior cancer(P<0.001).No significant differences in cancerspecific survival were observed in terms of the different sites of the prior cancers and the different interval periods of prior cancers and Pan NETs(P<0.05).Conclusions Patients with localized Pan NETs and a history of prior cancer had survival outcomes that were comparable to those of patients with no history of prior cancer.Patients with localized Pan NETs and prior cancer could be candidates for clinical trials if they satisfy all other conditions;aggressive and potentially curative therapies should be offered to these patients.