不同类型胃恶性神经内分泌肿瘤与胃腺癌的临床病理特征和生存情况比较  

Comparison of clinicopathological characteristics and overall survival between different types of gastric malignant neuroendocrine neoplasms and gastric adenocarcinoma

作　　者：张奔龙 高云鹤[1] 鲁意迅 李力[1] 梁文全[1] 郗洪庆[1] 王鑫鑫[1] 张珂诚 陈凛[1] ZHANG Benlong;GAO Yunhe;LU Yixun;LI Li;LIANG Wenquan;XI Hongqing;WANG Xinxin;ZHANG Kecheng;CHEN Lin(Department of General Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心普通外科医学部,北京100853

出　　处：《解放军医学院学报》2023年第4期324-332,共9页Academic Journal of Chinese PLA Medical School

基　　金：国家自然科学基金项目(82103593,81972790);北京市自然科学基金项目(7214252);军委后勤保障部面上项目(20BJZ39)。

摘　　要：背景胃恶性神经内分泌肿瘤包括胃神经内分泌癌和含有神经内分泌癌成分的混合性神经内分泌-非神经内分泌肿瘤,混合性神经内分泌-非神经内分泌肿瘤绝大多数为腺-神经内分泌癌,因其罕见性,目前缺乏系统性的研究提高对其临床病理特征及预后的认识。目的以胃腺癌为参照,探究胃恶性神经内分泌肿瘤的临床病理特征和生存情况。方法采用回顾性病例对照研究的方法,收集2008年1月-2018年12月在解放军总医院第一医学中心行手术治疗的非cM1期胃恶性神经内分泌肿瘤及胃腺癌患者资料,分析、比较其临床病理特征。1:3倾向性评分匹配(PSM)调整胃恶性神经内分泌肿瘤和胃腺癌队列之间的混杂因素。Kaplan-Meier法绘制生存曲线,log-rank检验分析组间总生存率的差异,Cox回归模型分析患者预后的独立关联因素。结果共纳入5443例(96.0%)胃腺癌与226例(4.0%)胃恶性神经内分泌肿瘤,后者包括148例神经内分泌癌和78例腺-神经内分泌癌。胃恶性神经内分泌肿瘤与胃腺癌首诊年龄、性别、肿瘤大小、肿瘤部位、手术方法、胃切除方式、T分期、N分期、TNM分期的差异有统计学意义(P<0.05)。2875例胃腺癌和215例胃恶性神经内分泌肿瘤有完整的生存信息,倾向性匹配后进行生存分析,发现胃腺癌患者的总生存率显著优于胃恶性神经内分泌肿瘤患者(3年、5年生存率:67.3%vs 58.9%,59.8%vs 48.3%,P=0.002),亚组分析显示,胃腺癌患者的总生存率优于神经内分泌癌和腺-神经内分泌癌患者(3年、5年生存率:67.3%vs 57.5%和61.1%,59.8%vs 50.5%和44.9%,P均<0.05),但神经内分泌癌患者与腺-神经内分泌癌患者的总生存率无统计学差异(P=0.993)。对胃恶性神经内分泌肿瘤的分析显示,神经内分泌癌与腺-神经内分泌癌在首诊年龄、性别、肿瘤大小、肿瘤部位、手术方法、胃切除方式、T分期、N分期、TNM分期、免疫标记物表�Background Gastric malignant neuroendocrine neoplasms(NEN)include neuroendocrine carcinoma(NEC)and mixed neuroendocrine&non-neuroendocrin(MiNEN)containing NEC components.The majority of MiNEN is mixed adenoendocrine carcinoma(MANEC).Because of its rarity,there is a lack of systematic research in improving the understanding of its clinicopathological characteristics and prognosis.Objective To explore the clinicopathological characteristics and the overall survival rate(OS)of gastric malignant NEN taking gastric adenocarcinoma as reference.Methods A retrospective case control study was performed in the clinical data about non cM1 gastric malignant NEN and gastric adenocarcinoma patients who underwent surgical treatment in the First Medical Center of Chinese PLA General Hospital from January 2008 to December 2018,and their clinicopathological characteristics were analyzed and compared.An 1:3 Tendency score matching(PSM)was used to adjust the confounding factors between gastric malignant NEN and gastric adenocarcinoma cohort.Kaplan-Meier method was used to draw survival curve.Log-rank test was used to analyze the difference of overall survival(OS)rate among groups.Cox regression model was used to analyze the independent risk factors affecting the prognosis of patients.Results The clinicopathological information of 5669 patients was included,including 5443(96.0%)cases of gastric adenocarcinoma and 226(4.0%)cases of gastric malignant NEN.Gastric malignant NEN included 148 cases of NEC and 78 cases of MANEC.There were statistically significant differences between gastric malignant NEN patients and gastric adenocarcinoma patients in age,sex,tumor size,tumor location,surgical approach,type of gastrectomy,T stage,N stage and TNM stage(all P<0.05).A total of 2875 patients with gastric adenocarcinoma and 215 patients with gastric malignant NEN had complete survival information.After PSM,the OS of patients with gastric adenocarcinoma was significantly better than that of patients with gastric malignant NEN(3-year,5-year OS:67

关 键 词：胃 神经内分泌癌 腺癌 总体生存率 倾向性评分匹配 

分 类 号：R735[医药卫生—肿瘤]