目的:本研究旨在探讨手术在大细胞神经内分泌癌(LCNC)患者中的预后意义。
方法:监测共453例患者,流行病学,分析2010年至2015年诊断为T1-4N0-2M0期LCNC的最终结果数据库。使用比率为1:1的倾向评分匹配分析来最小化其他临床特征的偏倚效应,77对患者数据进行后续统计分析.Cox比例风险模型,Kaplan-Meier分析,本研究采用对数秩检验。主要观察终点是癌症特异性生存率(CSS)。
结果:1年,3年,5年CSS率为60.0%,45.0%,453例LCNC患者中占42.0%。与接受手术切除的患者相比,没有手术的患者5年CSS率较低(18.0%vs.52.0%,P<0.001)。在多变量Cox回归分析后,化疗,T级,N级,和手术是独立的预后指标(均P<0.05)。在老年患者队列中,术后患者的中位生存时间长于未手术患者(13.0个月vs.NA,P<0.001)。此外,在具有不同临床特征的患者中,接受手术是保护性预后因素(所有风险比<1,所有P<0.05).此外,对于T1-2N0-2M0期的队列,术后患者的预后比没有手术的患者改善更多(P<0.001).
结论:我们提出手术可以改善T1-4N0-2M0期LCNC患者的生存结果。此外,老年患者可以从手术中受益。
OBJECTIVE: This study aimed to investigate the prognostic significance of surgery in large-cell neuroendocrine carcinoma (LCNC) patients.
METHODS: A total of 453 patients from the Surveillance, Epidemiology, and End Results database diagnosed with stage T1-4N0-2M0 LCNC from 2010 to 2015 were analyzed. The propensity-score matching analysis with a ratio of 1:1 was used to minimize the bias effect of other clinical characteristics, and 77 pairs of patients\' data were performed for subsequent statistical analysis. The Cox proportional hazards model, Kaplan-Meier analysis, and Log-rank test were used in the present study. The primary observational endpoint was cancer-specific survival (CSS).
RESULTS: The 1-year, 3-year, and 5-year CSS rates were 60.0%, 45.0%, and 42.0% in those 453 LCNC patients. Compared with patients who underwent surgical resection, patients without surgery had a lower 5-year CSS rate (18.0% vs. 52.0%, P < 0.001). After analyses of multivariable Cox regression, chemotherapy, T stage, N stage, and surgery were identified as independent prognostic indicators (all P < 0.05). In the cohort of old patients, the median survival time was longer in cases after surgery than those without surgery (13.0 months vs. NA, P < 0.001). Besides, in patients with different clinical characteristics, the receiving surgery was a protective prognostic factor (all hazard ratio < 1, all P < 0.05). In addition, for the cohort with stage T1-2N0-2M0, patients after the operation had more improved outcomes than patients without surgery (P < 0.001).
CONCLUSIONS: We proposed that the surgery could improve the survival outcomes of LCNC patients with stage T1-4N0-2M0. Moreover, old patients could benefit from surgery.