摘要
目的探讨非功能性胰腺神经内分泌癌(NF-PanNEC)患者预后的影响因素.方法收集美国国立癌症研究所监测、流行病学和结果(SEER)数据库中2004至2015年间病理明确诊断为NF-PanNEC的病例.使用R软件中的MatchIt包对手术、放疗、化疗的数据进行倾向性匹配分析,采用Kaplan-Meier法进行生存分析;log-rank检验分析比较生存率的差别;多因素Cox回归分析研究NF-PanNEC患者预后的影响因素.结果2 603例NF-PanNEC患者纳入本项研究.单因素分析显示诊断年龄(χ^2=123.8,P<0.001)、性别(χ^2=7.3,P=0.007)、婚姻状态(χ^2=26.7,P<0.001)、原发肿瘤部位(χ^2=47.8,P<0.001)、肿瘤分化程度(χ^2=628.7,P<0.001)、美国癌症联合委员会(AJCC)分期(χ^2=811.7,P<0.001)、T分期(χ^2=425.9,P<0.001)、N分期(χ^2=272.3,P<0.001)、M分期(χ^2=779.8,P<0.001)、手术(χ^2=962.6,P<0.001)、化疗(χ^2=21.9,P<0.001)与患者的预后相关,放疗(χ^2=0.1,P=0.750)与患者的预后无相关性.多因素Cox回归分析显示高龄(年龄≥74岁∶年龄≤56岁,HR=2.20,95%CI=1.84~2.62,P<0.001)、男性(男∶女,HR=1.14,95%CI为1.01~1.29,P=0.035)、单身/离婚/丧偶(单身/离婚∶已婚,HR=1.26,95%CI为1.10~1.45,P=0.001;丧偶∶已婚,HR=1.29,95%CI为1.04~1.61,P=0.022)、胰头部肿瘤(胰尾∶胰头,HR=0.85,95%CI为0.73~0.99,P=0.033)、低分化(Ⅳ级∶Ⅰ级,HR=3.75,95%CI为2.70~5.20,P<0.001)、AJCC分期较晚(Ⅳ期∶Ⅰ期,HR=5.72,95%CI为4.23~7.73,P<0.001)、未行手术治疗(手术∶未行手术,HR=0.37,95%CI为0.30~0.44,P<0.001)是NF-PanNEC患者独立的预后危险因素,化疗与患者的预后无相关性(化疗∶未行化疗,HR=1.00,95%CI为0.88~1.13,P=0.958).结论高龄、单身/离婚/丧偶、胰头部肿瘤、低分化、AJCC分期较晚、未行手术治疗是NF-PanNEC患者独立的预后危险因素,放疗和化疗可能不能改善NF-PanNEC患者的预后.
Objective To investigate the prognosis factors of patients with non-functional pancreatic neuroendocrine carcinoma (NF-PanNEC). MethodsThe patients with NF-PanNEC confirmed by pathology from 2004 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database of the American National Cancer Institute. The MatchIt package in the R software was used to perform propensity-matching analysis of surgery, radiotherapy and chemotherapy. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the significant difference was evaluated by the log-rank test. Then the Cox multivariate regression analysis was applied to evaluate the prognostic factors of NF-PanNEC patients. ResultsA total of 2 603 NF-PanNEC patients were included in the analysis. Univariate analysis showed that the age of diagnosis (χ^2=123.8, P<0.001), gender (χ^2=7.3, P=0.007), marital status (χ^2=26.7, P<0.001), primary site of tumor (χ^2=47.8, P<0.001), degree of tumor differentiation (χ^2=628.7, P<0.001), American Joint Committee on Cancer (AJCC) stage (χ^2=811.7, P<0.001), T stage (χ^2=425.9, P<0.001), N stage (χ^2=272.3, P<0.001), M stage (χ^2=779.8, P<0.001), surgery (χ^2=962.6, P<0.001), chemotherapy (χ^2=21.9, P<0.001) were associated with the prognosis of NF-PanNEC patients. No correlation was observed between radiotherapy and the prognosis of NF-PanNEC patients (χ^2=0.1, P=0.750). Multivariate Cox regression analysis showed that older diagnostic age (≥74 years old vs.≤56 years old, HR=2.20, 95%CI: 1.84-2.62, P<0.001), male (male vs. female, HR=1.14, 95%CI为1.01~1.29, P=0.035), single or divorced or widowed (single or divorced vs. married, HR=1.26, 95%CI: 1.10-1.45, P=0.001;widowed vs. married, HR=1.29, 95%CI: 1.04-1.61, P=0.022), head of pancreas (tail of pancreas vs. head of pancreas, HR=0.85, 95%CI: 0.73-0.99, P=0.033), poor differentiation (grade Ⅳ vs. grade Ⅰ, HR=3.75, 95%CI: 2.70-5.20, P<0.001), late AJCC stage (stage Ⅳ vs. stage Ⅰ, HR=5.72, 95%CI: 4.23-7.73, P<0.001),
作者
陈罗军
李娜
田景媛
许斌
宋启斌
Chen Luojun;Li Na;Tian Jingyuan;Xu Bin;Song Qibin(Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, Chirm)
出处
《国际肿瘤学杂志》
CAS
2018年第12期721-726,共6页
Journal of International Oncology
关键词
胰腺肿瘤
癌
神经内分泌
预后
SEER规划
Pancreatic neoplasms
Carcinoma, neuroendocrine
Prognosis
SEER program
