国际肿瘤学杂志

国际肿瘤学杂志 ›› 2018, Vol. 45 ›› Issue (12): 721-726.doi: 10.3760/cma.j.issn.1673-422X.2018.12.004

• 论著 • 上一篇    下一篇

非功能性胰腺神经内分泌癌的预后因素分析

陈罗军,李娜,田景媛,许斌,宋启斌   

  1. 430060 武汉大学人民医院肿瘤中心（陈罗军、李娜、许斌、宋启斌），消化内科（田景媛）
  • 出版日期:2018-12-08 发布日期:2019-02-01
  • 通讯作者: 宋启斌 E-mail:qibinsong@163.com
  • 基金资助:

    国家自然科学基金（81372407）；湖北省自然科学基金（2015CFB409）

Analysis of prognosis factors in nonfunctional pancreatic neuroendocrine carcinoma

Chen Luojun, Li Na, Tian Jingyuan, Xu Bin, Song Qibin   

  1. Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China
  • Online:2018-12-08 Published:2019-02-01
  • Contact: Song Qibin E-mail:qibinsong@163.com
  • Supported by:

    National Natural Science Foundation of China (81372407); Natural Science Foundation of Hubei Province of China (2015CFB409)

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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（χ2=123.8，P<0.001）、性别（χ2=7.3，P=0.007）、婚姻状态（χ2=26.7，P<0.001）、原发肿瘤部位（χ2=47.8，P<0.001）、肿瘤分化程度（χ2=628.7，P<0.001）、美国癌症联合委员会（AJCC）分期（χ2=811.7，P<0.001）、T分期（χ2=425.9，P<0.001）、N分期（χ2=272.3，P<0.001）、M分期（χ2=779.8，P<0.001）、手术（χ2=962.6，P<0.001）、化疗（χ2=21.9，P<0.001）与患者的预后相关，放疗（χ2=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。

关键词: 胰腺肿瘤, 癌, 神经内分泌, 预后, SEER规划

Abstract: ObjectiveTo 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 (χ2=123.8, P<0.001), gender (χ2=7.3, P=0.007), marital status (χ2=26.7, P<0.001),  primary site of tumor (χ2=47.8, P<0.001), degree of tumor differentiation (χ2=628.7, P<0.001),  American Joint Committee on Cancer (AJCC) stage (χ2=811.7, P<0.001), T stage (χ2=425.9, P<0.001), N stage (χ2=272.3, P<0.001), M stage (χ2=779.8, P<0.001), surgery (χ2=962.6, P<0.001), chemotherapy (χ2=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 (χ2=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), no surgery treatment (yes vs. no, HR=0.37, 95%CI: 0.300.44, P<0.001) were significant prognostic risk factors for NFPanNEC patients, and chemotherapy was not independent prognostic factor (yes vs. no, HR=1.00, 95%CI: 0.881.13, P=0.958). ConclusionThe older diagnostic age, single or divorced or windowed, head of pancreas, poor differentiation, late AJCC stage and no surgery treatment are significant prognostic risk factors for NFPanNEC patients. Radiotherapy and chemotherapy may not improve the prognosis of NFPanNEC patients.

Key words: Pancreatic neoplasms, Carcinoma, neuroendocrine, Prognosis, SEER program