背景:内镜治疗(ET)和手术切除(SR)是治疗结直肠神经内分泌肿瘤(CRNETs)的常用手术方法。然而,对于老年患者,目前尚不清楚哪种手术方法可获得更好的长期结局.
方法:从监测中确定了2000年至2020年诊断的≥65岁的CRNETs患者,流行病学,和结束结果数据库。使用倾向评分匹配(PSM)来最小化选择偏差。使用Kaplan-Meier方法和Cox比例风险模型来评估各种人口统计学和临床因素对总生存期(OS)和癌症特异性生存期(CSS)的影响。
结果:共2214例患者被纳入研究,ET组1417例,SR组797例。PSM之后,ET组在OS(风险比[HR]0.56,95%置信区间[CI]0.44-0.70)和CSS(HR0.21,95%CI0.11-0.40)方面优于SR组.同样,ET组保持了在1-,3-,与SR组相比,5年OS和CSS率(P<0.001)。多变量Cox回归分析确定的年龄,性别,grade,婚姻状况,和治疗方式是影响OS的独立危险因素,而年龄,性别,婚姻状况,和治疗方式被确定为影响CSS的独立危险因素。
结论:ET为≥65岁的CRNETs老年患者提供了优越的长期结局。
BACKGROUND: Endoscopic therapy (ET) and surgical resection (SR) are common surgical methods for the treatment of colorectal neuroendocrine tumors (CRNETs). However, for elderly patients, it remains unclear which surgical method yields better long-term outcomes.
METHODS: Elderly patients ≥ 65 years with CRNETs diagnosed from 2000 to 2020 were identified from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to minimize selection bias. The Kaplan-Meier method and Cox proportional hazards models were utilized to evaluate the effects of diverse demographic and clinical factors on overall survival (OS) and cancer-specific survival (CSS).
RESULTS: A total of 2214 patients were included in the study, with 1417 patients in the ET group and 797 patients in the SR group. After PSM, the ET group outperformed the SR group in terms of OS (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.44-0.70) and CSS (HR 0.21, 95% CI 0.11-0.40). Similarly, the ET group maintained its advantage in mean 1-, 3-, and 5-year OS and CSS rates compared to the SR group (P < 0.001). Multivariate Cox regression analysis identified age, sex, grade, marital status, and treatment modality as independent risk factors affecting OS, while age, sex, marital status, and treatment modality were identified as independent risk factors affecting CSS.
CONCLUSIONS: ET offered superior long-term outcomes for elderly patients ≥ 65 years with CRNETs.