中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (9): 807-817.doi: 10.19401/j.cnki.1007-3639.2022.09.008

• 专题论著 • 上一篇    下一篇

辅助化疗对胃神经内分泌癌患者预后的意义

张日虹1(), 郭宇2, 梁贇3, 陈洛海2, 陈洁3(), 王玮1()   

  1. 1.中山大学肿瘤防治中心胃外科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广东 广州 510060
    2.中山大学附属第一医院消化内科,广东 广州 510080
    3.复旦大学附属肿瘤医院神经内分泌肿瘤中心,头颈及神经内分泌肿瘤内科,复旦大学上海医学院肿瘤学系,上海 200032
  • 收稿日期:2022-08-02 修回日期:2022-09-07 出版日期:2022-09-30 发布日期:2022-10-24
  • 通信作者: 陈洁,王玮
  • 作者简介:张日虹(ORCID: 0000-0002-5667-1597),硕士。
    王玮,中山大学肿瘤防治中心胃外科副主任医师。中国抗癌协会胰腺癌专业委员会神经内分泌肿瘤学组委员,中国医疗保健国际交流促进会神经内分泌肿瘤专业委员会委员,广东省抗癌协会胃癌专业委员会青委会委员兼秘书,广东省中西医结合协会胃肠外科分会委员。主持国家自然科学基金青年项目、广州市产学研协同创新重大专项、广东省自然科学基金面上项目、广东省卫健委面上项目及教育部博士点专项基金青年基金等多项课题。近5年以第一作者在SCI收录期刊上发表论文20余篇。
  • 基金资助:
    国家自然科学基金青年项目(81802451);国家自然科学基金“罕见肿瘤研究专项”项目(82141104);广东省自然科学基金面上项目(2018A030313827);广东省自然科学基金面上项目(2021A1515011327)

Prognostic significance of adjuvant chemotherapy in patients with gastric neuroendocrine carcinoma

ZHANG Rihong1(), GUO Yu2, LIANG Yun3, CHEN Luohai2, CHEN Jie3(), WANG Wei1()   

  1. 1. Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
    2. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
    3. Center for Neuroendocrine Tumors, Department of Head, Neck and Neuroendocrine Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
  • Received:2022-08-02 Revised:2022-09-07 Published:2022-09-30 Online:2022-10-24
  • Contact: CHEN Jie, WANG Wei

摘要:

背景与目的: 胃神经内分泌肿瘤(neuroendocrine neoplasm,NEN)是胃恶性肿瘤中一种较为罕见的类别,根据2019年世界卫生组织(World Health Organization,WHO)消化系统NEN的分类标准,分为分化好的神经内分泌瘤(neuroendocrine tumor,NET)和分化差的神经内分泌癌(neuroendocrine carcinoma,NEC)。目前,关于胃NEC(gastric NEC,GNEC)辅助化疗预后的研究匮乏,本研究旨在探讨辅助化疗能否使GNEC患者获益,以期为临床决策提供参考依据。方法: 回顾性分析中山大学肿瘤防治中心、中山大学附属第一医院和复旦大学附属肿瘤医院2008年7月—2019年6月收治的184例GNEC患者的临床病理学资料,随访截至2022年5月31日。利用Kaplan-Meier法绘制生存曲线,根据单因素COX回归分析和多因素COX回归分析筛选出影响GNEC患者生存的独立预后因素,并进一步分析化疗、手术等因素对患者预后的影响。检验水准为α = 0.05,所有统计学分析均使用SPSS 25.0软件。结果: 单因素分析显示,手术(P<0.001)、化疗(P <0.001)、综合治疗模式(P<0.001)、N分期(P = 0.029)、M分期(P<0.001)及TNM综合分期(P<0.001)是影响GNEC患者预后的变量。多因素COX回归分析显示,手术(P<0.001)、化疗(P<0.001)及M分期(P<0.001)是影响GNEC患者生存的独立预后因素。在所有患者中,TNM Ⅰ、Ⅱ、Ⅲ和Ⅳ期的3年累积生存率分别为51.9%、55.8%、40.7%和23.6%。在行根治性切除的患者中,辅助化疗可以改善GNEC患者的预后,辅助化疗和非辅助化疗的3年累积生存率分别为58.8%和33.3%(P = 0.008)。分层分析结果显示,辅助化疗能够改善TNM Ⅱ(P = 0.018)和Ⅲ期(P = 0.023)患者的预后。此外,NEC化疗方案[依托泊苷+顺铂(etoposide plus cisplatin,EP)、伊立替康+顺铂(irinotecan plus cisplatin,IP)]与胃腺癌方案[奥沙利铂+卡培他滨(oxaliplatin plus capecitabine,XELOX)、奥沙利铂+替吉奥(oxaliplatin plus tegafur,SOX)、奥沙利铂+5-氟尿嘧啶(oxaliplatin plus 5-fluorouracil,FOLFOX)]在改善预后方面差异无统计学意义(P = 0.668)。结论: 辅助化疗可改善GNEC患者预后,为临床决策提供参考。

关键词: 胃神经内分泌癌, 辅助化疗, 预后

Abstract:

Background and purpose: Gastric neuroendocrine neoplasm (NEN) is a rare type of gastric malignant tumors. According to the 2019 World Health Organization (WHO) classification criteria for gastrointestinal NEN, gastric NEN can be divided into well-differentiated neuroendocrine tumor (NET) and poorly-differentiated neuroendocrine carcinoma (NEC). At present, there is a lack of research on the prognosis of adjuvant chemotherapy for gastric NEC (GNEC). The aim of the research was to investigate whether adjuvant chemotherapy can benefit patients with GNEC and provide a basis for clinical decision-making. Methods: A retrospective analysis was performed on the clinical data of about 184 patients with GNEC from July 2008 to June 2019 in Sun Yat-sen University Cancer Center, The First Affiliated Hospital of Sun Yat-sen University and Fudan University Shanghai Cancer Center. The follow-up deadline was May 31, 2022. Kaplan-Meier method was used to draw the survival curve, and prognostic relevant factors affecting the survival of patients with GNEC and the independent prognostic factors were screened out according to univariate and multivariate COX regression analyses. Finally, the effects of chemotherapy and surgery on the prognosis of patients were further analyzed. The test level was α = 0.05, and SPSS 25.0 was used for all statistical analyses. Results: By univariate COX regression analysis, it was found that surgery, chemotherapy, treatment method, N stage, M stage and TNM stage were the variables affecting the prognosis of patients with GNEC (P<0.05). Multivariable COX regression analysis results showed that surgery, chemotherapy and M stage were independent prognostic factors for survival in patients with GNEC (P<0.001). The 3-year cumulative survival rates of TNM stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 51.9%, 55.8%, 40.7% and 23.6%, respectively. In the radical resection group, adjuvant chemotherapy could improve the prognosis of patients with GNEC (P=0.008). The 3-year cumulative survival rates of adjuvant chemotherapy group and non-adjuvant chemotherapy group were 58.8% and 33.3%, respectively. Stratified analysis showed that adjuvant chemotherapy could benefit the prognosis of patients with TNM stage Ⅱ (P = 0.018) and TNM stage Ⅲ (P = 0.023). In addition, there was no significant difference in prognosis between the first-line chemotherapy regimen [etoposide plus cisplatin (EP), irinotecan plus cisplatin (IP)] and the gastric adenocarcinoma regimen [oxaliplatin plus capecitabine (XELOX), oxaliplatin plus tegafur (SOX), oxaliplatin plus 5-fluorouracil (FOLFOX)] (P = 0.668). Conclusion: Adjuvant chemotherapy can significantly improve the prognosis of patients with GNEC, providing a reference for clinical decision-making.

Key words: Gastric neuroendocrine carcinoma, Adjuvant chemotherapy, Prognosis

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