目的:神经内分泌分化(NED)可作为结直肠癌的预后因素;NED的预后相关性仍存在争议.本研究的目的是确定NED是否影响结直肠癌患者的生存,同时探索其与其他临床病理特征的潜在相互作用。
方法:2010年至2015年的原发性I至IV期结直肠腺癌患者,流行病学,和结束结果数据库。Kaplan-Meier技术,Cox比例风险模型,倾向得分匹配,本研究采用了分层分析。
结果:共纳入94,291例患者(包括101例NED患者和94,190例非NED患者)。在单变量分析中,发现NED与显著较差的总生存期(死亡风险比(HR)=3.09,95%CI2.42-3.95,P<0.001)和癌症特异性生存期(死亡风险比=3.77,95%CI2.94-4.83,P<0.001)相关。此外,在调整多变量和倾向评分分析后,NED与总生存期(死亡HR=1.84,95%CI1.34-2.51,P<0.001)和癌症特异性生存期(死亡HR=2.01,95%CI1.45-2.79,P<0.001)保持独立相关。此外,进一步的分层分析表明,NED对生存的影响不受肿瘤位置的影响,分化,T级,和远处转移状态;然而,发现与淋巴结转移有关。
结论:NED与结直肠癌患者的不良生存结局相关,尤其是那些淋巴结阳性的患者.
OBJECTIVE: Neuroendocrine differentiation (NED) may serve as a prognostic factor in colorectal cancer; however, the prognostic relevance of NED remains controversial. The aim of the present
study was to determine whether NED influenced the survival of patients in colorectal cancer while exploring its potential interactions with other clinicopathological features.
METHODS: Patients with primary stage I to IV colorectal adenocarcinoma ranging between 2010 and 2015 were identified using the Surveillance, Epidemiology, and End Results database. The Kaplan-Meier technique, Cox proportional hazards model, propensity score matching, and stratification analyses were employed in this
study.
RESULTS: A total of 94,291 patients (including 101 patients with NED and 94,190 patients without NED) were included. In the univariable analyses, NED was found to be correlated with a significantly poorer overall survival (hazard ratio (HR) of death = 3.09, 95% CI 2.42-3.95, P < 0.001) and cancer-specific survival (HR of death = 3.77, 95% CI 2.94-4.83, P < 0.001). Moreover, NED remained independently correlated with overall survival (HR of death = 1.84, 95% CI 1.34-2.51, P < 0.001) and cancer-specific survival (HR of death = 2.01, 95% CI 1.45-2.79, P < 0.001) after adjusting in multivariable and propensity score analyses. Furthermore, further stratification analyses indicated that the influence of NED on survival was not affected by tumor location, differentiation, T stage, and distant metastasis status; however, it was found to be associated with lymph node metastasis.
CONCLUSIONS: NED is associated with poor survival outcomes among colorectal cancer patients, especially in those with positive lymph nodes.