基于SEER数据库分析胆管内乳头状黏液性肿瘤患者预后的影响因素

Prognostic factors of intraductal papillary mucinous neoplasm of the bile duct:analysis based on SEER database

目的探讨胆管内乳头状黏液性肿瘤(IPMN-B)患者预后的影响因素。方法从监测、流行病学和最终结果(SEER)数据库中回顾性收集2004年至2015年227例IPMN-B患者的临床资料,其中男性126例,女性101例,诊断年龄69(58,77)岁。IPMN-B患者依据是否行手术治疗分为两组:手术组(n=129)和未手术组(n=98)。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。单因素和多因素Cox回归模型分析IPMN-B患者独立预后因素。结果227例SEER数据库IPMN-B患者的肿瘤长径为25(18.5,45.0)mm。手术组和未手术组患者在肿瘤长径、分化程度、美国癌症联合委员会(AJCC)分期、T分期、M分期、化疗方面差异均具有统计学意义(均P<0.05)。227例IPMN-B患者中位生存时间为14个月,1年累积生存率为53.4%。手术组患者中位生存时间27个月,优于未手术组患者的中位生存时间5个月,差异具有统计学意义(P<0.001)。单因素Cox分析显示,AJCC分期、T分期、N分期、M分期、手术是IPMN-B患者预后的影响因素(均P<0.05)。多因素Cox分析表明,M1分期(HR=2.125,95%CI:1.472~3.066,P<0.001)是IPMN-B患者预后不良的独立危险因素,而手术(HR=2.983,95%CI:2.106~4.224,P<0.001)是影响IPMN-B患者预后的保护因素。结论AJCC分期系统是评估IPMN-B患者预后的重要预测因子,手术可改善IPMN-B患者的预后。

Objective To explore prognostic factors of intraductal papillary mucinous neoplasm of the bile duct(IPMN-B)patients.Methods Clinical data on 227 patients with IPMN-B between 2004 and 2015 were retrospectively collected from the surveillance,epidemiology,and end results(SEER)database.There were 126 male and 101 female patients with the age at diagnosis of 69(58,77)years old.IPMN-B patients were divided into two groups based on whether surgical treatment was performed.There were 129 patients in the surgery group and 98 patients in the non-surgery group.The survival analyses were assessed by Kaplan-Meier analyses and log-rank test was used to compared survival rate.The univariate and multivariate Cox analyses were applied to find independent prognostic factors of the survival in IPMN-B patients.Results The tumor size of 227 IPMN-B patients from the SEER database was 25(18.5,45.0)mm.The differences of tumor size,grade of defferentiation,American Joint Committee on Cancer(AJCC)stage,T stage,M stage chemotherapy were statistically significant respectively in surgery group and non-surgery group(all P<0.05).The median overall survival time(OS)of patients with IPMN-B was 14 months and the overall 1-year survival was 53.4%.The median overall survival time of IPMN-B patients in surgery group was 27 months,which was better than 5 months of patients in non-surgery group,and the difference was statistically significant(P<0.001).Univariate Cox analysis found AJCC stage,T stage,N stage,M stage and surgery were prognostic factors in patients with IPMN-B.Multivariate Cox analysis showed that M1 stage(HR=2.125,95%CI:1.472-3.066,P<0.001)was independent risk factor of prognosis while surgery(HR=2.983,95%CI:2.106-4.224,P<0.001)was independent protective factor of prognosis.Conclusion The AJCC staging system is an important predictor for evaluating the prognosis of IPMN-B patients.Surgery could significantly improve the prognosis of patients with IPMN-B.