原发灶切除术联合化疗可改善转移性结直肠神经内分泌癌患者生存  

Resection of primary lesion with chemotherapy improves the survival of patients with metastatic colorectal neuroendocrine carcinoma

作　　者：王庆华[1] 尹瑞华 汤婉芬 李成辉 郑红娟 张霞 金霞云 应明亮 傅健飞[1] WANG Qinghua;YIN Ruihua;TANG Wanfen;LI Chenghui;ZHENG Hongjuan;ZHANG Xia;JIN Xiayun;YING Mingliang;FU Jianfei(Department of Medical Oncology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,Zhejiang Province,China;Department of Medical Imaging,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,Zhejiang Province,China)

机构地区：[1]浙江大学医学院附属金华医院肿瘤内科,浙江金华321000 [2]浙江大学医学院附属金华医院影像科,浙江金华321000

出　　处：《浙江大学学报（医学版）》2022年第5期594-602,共9页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省自然科学基金(LY19H160020);金华市中心医院中青年科研基金启动项目(JY2021-1-01);金华市科技计划(2020-3-037)。

摘　　要：目的:评估原发灶切除术及化疗对转移性结直肠神经内分泌癌(CRNEC)患者生存的影响。方法:回顾性分析监测、流行病学和最终结果(SEER)数据库2010年1月至2016年12月收录的转移性CRNEC患者的资料,通过倾向评分匹配法1∶1匹配均衡组间差异,用Kaplan-Meier、Log-rank等方法比较不同治疗方式患者生存差异,通过Cox比例风险回归模型分析影响生存的因素。选取2001年1月至2021年12月浙江大学医学院附属金华医院符合相同筛选条件的转移性CRNEC病例进行结果验证。结果:SEER数据库提取393例符合选择标准的转移性CRNEC患者,其中接受原发灶切除术172例,未行手术221例,倾向评分匹配后纳入的原发灶切除术患者和未手术患者各172例。生存分析结果显示,与未手术患者比较,原发灶切除术患者肿瘤特异性生存时间更长(P<0.05);而与术中阳性淋巴结数8枚及以下的患者比较,术中阳性淋巴结数8枚以上的患者预后较差(P<0.05)。回归分析结果显示,性别、原发肿瘤部位及治疗方式是影响转移性CRNEC患者肿瘤特异性生存的独立危险因素(均P<0.05);对于接受原发灶切除术的CRNEC患者,直肠神经内分泌癌、阳性淋巴结数8枚及以下、原发灶切除术联合化疗的治疗方式与患者肿瘤特异性生存时间更长相关(均P<0.05)。结论:原发灶切除术可为转移性CRNEC患者带来生存获益,原发灶切除术联合化疗的效果优于单纯原发灶切除术,且术中阳性淋巴结数与患者的预后密切相关。Objective:To evaluate the effect of resection of primary lesion and chemotherapy on survival of patients with metastatic colorectal neuroendocrine carcinoma(CRNEC).Methods:Clinical data of 393 patients with metastatic CRNECs between January 2010 and December 2016 were extracted from the Surveillance,Epidemiology,and End Results(SEER)database,including 171 patients who received resection of primary lesion and 221 patients who did not undergo surgery.With the propensity score matching method 172 non-operated patients were selected as controls.Kaplan-Meier method and Log-rank test were used to evaluate the survival differences,while the prognostic factors were analyzed by Cox proportional-hazards model.Metastatic CRNEC patients from January 2001 to December 2021 in Affiliated Jinhua Hospital,Zhejiang University School of Medicine were selected for validation.Results:Compared with non-operated patients,patients who received resection had longer cause-specific survival(P<0.05).Patients with resected positive lymph nodes>8 had a poorer prognosis compared to those with resected positive lymph nodes≤8(P<0.05).Multivariate analysis showed that gender,location of primary lesion and treatments were independent risk factors for cause-specific survival in patients with metastatic CRNEC(all P<0.05).For metastatic CRNEC patients with resection of primary lesion,rectal neuroendocrine carcinoma,positive resected lymph nodes≤8 and resection of primary lesion combined with chemotherapy were associated with better cause-specific survival(all P<0.05).Conclusions:Patients with metastatic CRNEC may benefit from resection of primary lesion,and resection of primary lesion combined with chemotherapy might be the better strategy for metastatic CRNECs.The number of positive lymph nodes resected is correlated with the prognosis of patients.

关 键 词：结直肠神经内分泌癌 监测、流行病学和最终结果数据库 手术 化疗 预后 

分 类 号：R735.3[医药卫生—肿瘤]