基于SEER数据库的腹膜后恶性纤维组织细胞瘤的临床病理特点及预后分析

Clinicopathological features and prognosis of retroperitoneal malignant fibrous histiocytoma based on SEER database

目的:比较腹膜后恶性纤维组织细胞瘤(MFH)的临床特点,分析影响其预后的独立危险因素。方法:提取美国癌症监测、流行病学和结果(SEER)数据库2000—2018年经病理学确诊并且有完整的随访记录资料的腹膜后恶性肿瘤患者,根据国际疾病分类肿瘤学专辑第三版(ICD-O-3)分类标准,分为MFH和其他类型恶性肿瘤两类,对其临床病理资料进行回顾性分析。采用Kaplan-Meier曲线进行生存分析,并构建Cox回归模型分析探索影响腹膜后MFH患者远期预后的独立影响因素。结果:共纳入4653例腹膜后恶性肿瘤患者,中位随访时间37个月(IQR:13~91个月),其中MFH 118例,中位生存时间20个月。其1年、3年、5年生存率分别为62.83%、34.47%、28.12%;其他类型恶性肿瘤患者4535例,中位生存时间70个月。其1年、3年、5年生存率分别为:80.46%、62.18%、52.88%。Log-rank检验显示,两者间差异有统计学意义(χ^(2)=57.77,P<0.001)。Cox单因素分析显示,在MFH患者组中,仅手术治疗(P<0.001)是影响患者预后的因素;而年龄、性别、种族、放疗、化疗、肿瘤分化程度均不是影响MFH患者预后的因素(均P>0.05)。Cox多因素分析通过调整了年龄、性别、分化程度、化疗对患者的预后影响后,显示手术治疗是患者预后的独立危险因素(P<0.001)。在其他类型恶性肿瘤组中,Cox单因素分析显示,年龄、性别、手术、化疗、肿瘤分化程度与患者预后相关(均P<0.05)。Cox多因素分析显示,年龄、性别、化疗、手术、肿瘤分化程度是影响预后的独立因素(均P<0.05)。结论:MFH是腹膜后恶性肿瘤中发病较少、预后较差的病理学类型,手术治疗是改善患者预后的唯一手段。而其他病理学类型肿瘤中,年龄、性别、化疗、手术、肿瘤分化程度,均是影响患者预后的因素,因此应根据患者的具体情况制定个体化的治疗方案。

Objective: To compare the clinical features of retroperitoneal malignant fibrous histiocytoma(MFH) and analyze the independent risk factors affecting its prognosis. Methods: Patients with retroperitoneal malignant tumor and complete follow-up records,confirmed by pathology during 2000-2018 were extracted from Surveillance, Epidemiology, and End Results(SEER)database. According to international classification of diseases for oncology, third edition(ICD-O-3),thepatients was divided into MFH group and other types of malignant tumors group, and the clinicopathological data of the two group were analyzed retrospectively. Kaplan-Meier curve was used for survival analysis, and Cox regression model was established to analyze the independent factors affecting the long-term prognosis. Results: A total of 4653 patients with retroperitoneal malignant tumors were included in the analysis. The median follow-up time was37 months(IQR:13~91months). Of the 4653 patients, 118 patients were MFH group with a median survival time of 20months and the 1-, 3-and 5-year survival rates were 62.83%, 34.47% and 28.12%, respectively;4535 patients were the other types of malignant tumors group with a median survival time of 70months, and the 1-, 3-and 5-year survival rates were 80.46%, 62.18% and 52.88%, respectively.Log-rank test showed that there was significant difference between the two groups(χ~2=57.77). In the MFH group, Univariate and multivariate Cox analysis showed that only surgical treatment was the factor affecting the prognosis(P<0.001), and Age, sex, race, radiotherapy, chemotherapy and tumor differentiation were not the factors affecting the prognosis(all P>0.05);In other types of malignant tumor groups, Univariate analysis showed that age, sex, operation, chemotherapy and tumor differentiation were was associated with the prognosis(all P<0.05);Multivariate Cox analysis showed that age, sex, chemotherapy, surgery and tumor differentiation were independent factors affecting prognosis(all P<0.05). Conclusion: MFH is a pathological type with less incidence and poor prognosis in retroperitoneal malignant tumors. Surgical treatment is the only way to improve the overall survival of patients with MFH. In other pathological types of tumors, age, chemotherapy, surgery and tumor differentiation are the factors affecting the prognosis. Therefore, individualized treatment plans must be tailored to the individual patient.