辅助化疗对胃神经内分泌癌患者预后的意义

张日虹; 郭宇; 梁贇; 陈洛海; 陈洁; 王玮

doi:10.19401/j.cnki.1007-3639.2022.09.008

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辅助化疗对胃神经内分泌癌患者预后的意义

专题论著 | 更新时间：2025-12-31

- 辅助化疗对胃神经内分泌癌患者预后的意义
- Prognostic significance of adjuvant chemotherapy in patients with gastric neuroendocrine carcinoma
- 中国癌症杂志 2022年32卷第9期页码：807-817
- 作者机构：
  
  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
- 作者简介：
  
  [ "张日虹（ORCID: 0000-0002-5667-1597）,硕士。" ]
  王玮（ORCID: 0000-0002-3018-1629）,博士,副主任医师;
  [ "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。" ]
- 基金信息：
  
  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)
- DOI：10.19401/j.cnki.1007-3639.2022.09.008
  中图分类号： R735.2
- 收稿：2022-08-02，
  
  修回：2022-09-07，
  
  纸质出版：2022-09-30
- 稿件说明：
移动端阅览
张日虹, 郭宇, 梁贇, 等. 辅助化疗对胃神经内分泌癌患者预后的意义[J]. 中国癌症杂志, 2022,32(9):807-817.

Rihong ZHANG, Yu GUO, Yun LIANG, et al. Prognostic significance of adjuvant chemotherapy in patients with gastric neuroendocrine carcinoma[J]. China Oncology, 2022, 32(9): 807-817.
张日虹, 郭宇, 梁贇, 等. 辅助化疗对胃神经内分泌癌患者预后的意义[J]. 中国癌症杂志, 2022,32(9):807-817. DOI： 10.19401/j.cnki.1007-3639.2022.09.008.

Rihong ZHANG, Yu GUO, Yun LIANG, et al. Prognostic significance of adjuvant chemotherapy in patients with gastric neuroendocrine carcinoma[J]. China Oncology, 2022, 32(9): 807-817. DOI： 10.19401/j.cnki.1007-3639.2022.09.008.

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

#x02014;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

= 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（

0.001）、化疗（

0.001）、综合治疗模式（

0.001）、N分期（

= 0.029）、M分期（

0.001）及TNM综合分期（

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（

0.001）、化疗（

0.001）及M分期（

0.001）是影响GNEC患者生存的独立预后因素。在所有患者中

TNM

#x02160;、

#x02161;、

#x02162;和

#x02163;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%（

= 0.008）。分层分析结果显示

辅助化疗能够改善TNM

#x02161;（

= 0.018）和

#x02162;期（

= 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（

= 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。

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 r

esearch 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

#x003b1; = 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 (

0.05). Multivariable COX regression analysis results showed that surgery

chemotherapy and M stage were independent prognostic factors for survival in patients with GNEC (

0.001). The 3-year cumulative survival rates of TNM stage

#x02160;

#x02161;

#x02162; and

#x02163; 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 (

=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

#x02161; (

= 0.018) and TNM stage

#x02162; (

= 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)

]

(

= 0.668).

Conclusion:

Adjuvant chemotherapy can significantly improve the prognosis of patients with GNEC

providing a reference for clinical decision-making.

关键词

Keywords

references

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