Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States
Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States
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DOI：
10.1001/jamaoncol.2017.0589
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发表时间：
2017-10-01
期刊：
影响因子：
28.4
通讯作者：
Yao, James C.
中科院分区：
文献类型：
--
作者：
Dasari, Arvind;Shen, Chan;Yao, James C.
重要性神经内分泌肿瘤（NETs）的发病率和患病率被认为是上升的，但缺乏最新的流行病学数据。目的探讨不断发展的流行病学，并调查治疗进展对NETs患者生存率的影响。和最终结果（SEER）程序进行了评估64 971例NET患者从1973年至2012年。相关人群数据用于确定年年龄校正发病率、短期患病率和5年总生存率（OS）。评估了整个队列以及特定亚组（包括远端胃肠道NET和胰腺NET）2000年至2012年的生存趋势。分析于2015年12月至2017年2月进行。主要结果和指标神经内分泌肿瘤的发病率、患病率和OS率。结果在64 971例NET患者中，34 233例（52.7%）为女性。从1973年（1.09/10万）到2012年（6.98/10万），年龄调整后的发病率增加了6.4倍。这种增加发生在所有地点，阶段和等级。在SEER 18登记研究分组（2000-2012）中，肺部最高发生率为1.49/100 000，胃肠胰腺部位为3.56/100 000，原发部位未知的NET为0.84/100 000。截至2014年1月1日，美国20年有限时间内的NET患病率估计为171，321。在多变量分析中，中位5年OS率随分期、分级、诊断时年龄、原发部位和诊断时间段而显著变化。从2000-2004年期间到2009-2012年期间，所有NET的OS率均有所改善（风险比[HR]，0.79; 95% CI，0.73-0.85）。在这些时期之间的OS更大的增加，注意到在远端阶段胃肠道NET（HR，0.71; 95%CI，0.62-0.81）和远端阶段胰腺NET（HR，0.56; 95%CI，0.44-0.70）。结论和相关性NET的发病率和患病率稳步上升，可能是由于检测到早期疾病和阶段迁移。随着时间的推移，所有NET的生存率都有所改善，特别是对于远端胃肠道NET和胰腺NET，这反映了治疗的改善。这些数据将有助于确定未来研究方向的优先顺序。
IMPORTANCE The incidence and prevalence of neuroendocrine tumors (NETs) are thought to be rising, but updated epidemiologic data are lacking.OBJECTIVE To explore the evolving epidemiology and investigate the effect of therapeutic advances on survival of patients with NETs.DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results (SEER) program was conducted to evaluate 64 971 patients with NETs from 1973 to 2012. Associated population data were used to determine annual age-adjusted incidence, limited-duration prevalence, and 5-year overall survival (OS) rates. Trends in survival from 2000 to 2012 were evaluated for the entire cohort as well as specific subgroups, including distant-stage gastrointestinal NETs and pancreatic NETs. Analyses were conducted between December 2015, and February 2017.MAIN OUTCOMES AND MEASURES Neuroendocrine tumor incidence, prevalence, and OS rates.RESULTS Of the 64 971 cases of NETs, 34 233 (52.7%) were women. The age-adjusted incidence rate increased 6.4-fold from 1973 (1.09 per 100 000) to 2012 (6.98 per 100 000). This increase occurred across all sites, stages, and grades. In the SEER 18 registry grouping (2000-2012), the highest incidence rates were 1.49 per 100 000 in the lung, 3.56 per 100 000 in gastroenteropancreatic sites, and 0.84 per 100 000 in NETs with an unknown primary site. The estimated 20-year limited-duration prevalence of NETs in the United States on January 1, 2014, was 171 321. On multivariable analyses, the median 5-year OS rate varied significantly by stage, grade, age at diagnosis, primary site, and time period of diagnosis. The OS rate for all NETs improved from the 2000-2004 period to the 2009-2012 period (hazard ratio [HR], 0.79; 95% CI, 0.73-0.85). Even larger increases in OS between these periods were noted in distant-stage gastrointestinal NETs (HR, 0.71; 95% CI, 0.62-0.81) and distant-stage pancreatic NETs (HR, 0.56; 95% CI, 0.44-0.70).CONCLUSIONS AND RELEVANCE The incidence and prevalence of NETs are steadily rising, possibly owing to detection of early-stage disease and stage migration. Survival for all NETs has improved over time, especially for distant-stage gastrointestinal NETs and pancreatic NETs in particular, reflecting improvement in therapies. These data will help to prioritize future research directions.