Resection of at-risk mesenteric lymph nodes is associated with improved survival in patients with small bowel neuroendocrine tumors.
Resection of at-risk mesenteric lymph nodes is associated with improved survival in patients with small bowel neuroendocrine tumors.
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DOI：
10.1007/s00268-013-1918-8
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发表时间：
2013-07
影响因子：
2.6
通讯作者：
Fleming JB
中科院分区：
文献类型：
--
作者：
Landry CS;Lin HY;Phan A;Charnsangavej C;Abdalla EK;Aloia T;Nicolas Vauthey J;Katz MH;Yao JC;Fleming JB
小肠神经内分泌肿瘤通常转移到区域淋巴结(LNS)。单一机构的报告表明，去除LNS可以改善结果，但缺乏全面的数据。我们假设，在一个大型管理数据库中报告的淋巴清扫范围将与空肠和回肠神经内分泌肿瘤的总体存活率相关。对1977-2004年间空肠和回肠神经内分泌肿瘤患者的监测流行病学和最终结果数据库进行搜索。收集描述性的患者特征，包括确诊时的年龄、性别、种族、分级、原发肿瘤大小、LN状态、切除LN的数量、是否存在远处转移以及手术类型。统计分析仅限于仅有一个原发肿瘤的患者，以排除其他恶性肿瘤患者。采用单变量和多变量分析方法，分析切除的淋巴结数目和切除的淋巴结比率(阳性淋巴结数目/切除的总数目)，以确定对癌症特异性生存的影响。总共有1,364名患者被纳入这项分析。在单变量分析中，与报道的没有切除淋巴结的患者相比，切除任何淋巴结的患者与癌症特异性生存改善相关(p=0.0027)。在那些切除了任何淋巴结的患者中，切除标本中的中位数为8个，中位数LN比率为0.29(范围0-1)。在多变量分析(调整年龄和肿瘤大小)中，切除≤7淋巴结的患者比切除B7淋巴结的患者有更好的癌症特异性生存率(中位生存期未达到140个月)：风险比和95%可信区间为0.573(0.402，0.817)(p=0.002)。对大量外科患者的回顾表明，区域肠系膜淋巴清扫联合原发灶切除可提高小肠神经内分泌肿瘤患者的存活率。
Neuroendocrine tumors of the small intestine commonly metastasize to regional lymph nodes (LNs). Single-institution reports suggest that removal of LNs improves outcome, but comprehensive data are lacking. We hypothesized that the extent of lymphadenectomy reported in a large administrative database would be associated with overall survival for jejunal and ileal neuroendocrine tumors. A search of the Surveillance Epidemiology and End Results database was performed for patients with jejunal and ileal neuroendocrine tumors from 1977 to 2004. Descriptive patient characteristics were collected to include age at diagnosis, sex, race, grade, primary tumor size, LN status, number of LNs resected, presence of distant metastasis, and the type of operation. Statistical analyses were limited to patients with only one primary tumor to exclude patients with other malignancies. Univariate and multivariate analyses were performed to analyze the number of LNs resected and the LN ratio (number of positive LNs/total number of LNs removed) to determine the effect on cancer-specific survival. Altogether, 1,364 patients were included in this analysis. Removal of any LNs was associated with improved cancer-specific survival when compared to patients with no LN removal reported (p = 0.0027) on univariate analysis. Among those who had any LNs removed, a median of eight LNs were identified in resection specimens with a median LN ratio of 0.29 (range 0–1). On multivariate analysis (adjusting for age and tumor size), patients with ≤7 LNs removed experienced better cancer-specific survival than those with B7 LNs removed (median survival not reached vs. 140 months): hazard ratio and 95 % confidence interval were 0.573 (0.402, 0.817) (p = 0.002). This review of a large number of surgical patients demonstrates that regional mesenteric lymphadenectomy in conjunction with resection of the primary tumor is associated with improved survival of patients with small bowel neuroendocrine tumors.
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影响因子：
9.6
作者：
Landerholm, K.;Zar, N.;Jarhult, J.
通讯作者：
Jarhult, J.
影响因子：
45.3
作者：
Yao, James C.;Phan, Alexandria T.;Meric-Bernstam, Funda
通讯作者：
Meric-Bernstam, Funda
影响因子：
168.9
作者：
Pavel, Marianne E.;Hainsworth, John D.;Yao, James C.
通讯作者：
Yao, James C.
影响因子：
6.2
作者：
MARTIN, RG
通讯作者：
MARTIN, RG
DOI：
10.1016/j.bpg.2005.05.005
发表时间：
2005-10-01
影响因子：
3.2
作者：
Åkerström, G;Hellman, P;Hessman, O
通讯作者：
Hessman, O