T_(1)/T_(2)期胃神经内分泌肿瘤淋巴结转移相关因素分析及术式选择

Analysis of Factors Related to Lymph Node Metastasis in T_1/T_(2) Gastric Neuroendocrine Neoplasm and Selection of Surgical Methods

目的分析T_(1)/T_(2)期胃神经内分泌肿瘤(gastric neuroendocrine neoplasm,G-NEN)淋巴结转移规律及其相关因素,并比较不同术式患者的总生存率(overall surivial,OS)。方法收集SEER数据库中T_(1)/T_(2)期G-NEC患者的临床信息。将患者按有无淋巴结转移分组,采用多因素Logistic回归分析确定淋巴结转移的独立危险因素。将淋巴结阴性的患者按照内镜治疗和外科手术分组进行生存分析。结果824例患者中有45例(5.5%)患者发生淋巴结转移,其中T_(1)期淋巴转移率为2.8%(15/539),T_(2)期淋巴结转移率为10.5%(30/285)。多因素分析显示,性别、诊断年份、分化程度和肿瘤直径均为淋巴结转移的独立影响因素(P均<0.05)。未发生淋巴结转移的675例患者中,432例(64%)接受内镜治疗,243例(36%)行外科手术。T_(1)期肿瘤,内镜治疗组和外科手术组的10年OS分别为76.8%和84.5%。T_(2)期肿瘤两组10年OS分别为72.1%和72.7%。T_(1)/T_(2)期患者不同术式的生存比较,差异均无统计学意义(P均>0.05)。结论男性、诊断年份(2004~2007年)、低/未分化和肿瘤直径>20mm是淋巴结转移的独立危险因素。对于淋巴结阴性的T_(1)/T_(2)期患者,内镜治疗和外科手术的长期生存率相当。

Objective To analyze the lymph node metastasis of gastric neuroendocrine neoplasm(G-NEN)in T_(1)/T_(2) stage and its related factors,and compare the overall survival(OS)of patients with different surgical methods.Methods The clinical information of T_(1)/T_(2) G-NEC patients in SEER database was collected.The patients were divided into groups according to whether they had lymph node metastasis or not,and the independent risk factors of lymph node metastasis were determined by multivariate Logistic regression analysis.The patients with negative lymph nodes were divided into two groups according to endoscopic therapy and surgery for survival analysis.Results Among 824 patients,45 patients(5.5%)had lymph node metastasis.The lymph node metastasis rate in T_(1) was 2.8%(15/539),and in T_(2) was 10.5%(30/285).Multivariate analysis showed that gender,diagnosis year,differentiation degree and tumor diameter were independent influencing factors of lymph node metastasis(P<0.05).Among 675 patients without lymph node metastasis,432(64%)received endoscopic therapy and 243(36%)underwent surgery.The 10-year OS of T_(1),endoscopic therapy group and surgical operation group were 76.8%and 84.5%respectively.The 10-year OS of T_(2) was 72.1%and 72.7%respectively.There was no significant difference in the survival of T_(1)/T_(2) patients with different surgical methods(all P>0.05).Conclusion Male,year of diagnosis(2004-2007),poorly differentiated/undifferentiated and tumor diameter>20mm are independent risk factors for lymph node metastasis.For T_(1)/T_(2) patients with negative lymph nodes,the long-term survival rates of endoscopic therapy and surgery are similar.