Survival and prognostic factors in patients with small bowel carcinoid tumour
Survival and prognostic factors in patients with small bowel carcinoid tumour
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DOI：
10.1002/bjs.7649
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发表时间：
2011-11-01
影响因子：
9.6
通讯作者：
Jarhult, J.
中科院分区：
文献类型：
--
作者：
Landerholm, K.;Zar, N.;Jarhult, J.
背景：以往对小肠类癌肿瘤的研究通常提出总体或相对生存。此外，本研究还评估了地理上确定的人群中一组患者的疾病特异性生存率。方法：选取1960 ~ 2005年在延雪平县诊断为空肠或回肠类癌的患者。重新检查可用的肿瘤标本以确认诊断。详细审查了医疗记录和病理报告。结果：共纳入145例患者。135名患者接受了与诊断相关的手术。74例（54.8%）患者被认为完全切除（R0）。只有两个局部肿瘤复发，而没有远处转移的患者被治愈。局部转移患者行R0切除的生存率高于不完全切除的患者（P = 0.005），且大多数患者无复发。中位总生存期为7.2年，中位疾病特异性生存期为12.3年。在多变量分析中，年龄61-74岁（危险比3.78,95%可信区间1.86 - 7.68）、年龄75岁及以上（危险比3.96,1.79 - 8.74）、远处转移（危险比14.44,1.59 - 131.36）和肿瘤切除不完全（危险比2.71,1.11 - 6.61）与较差的疾病特异性生存相关。较晚的诊断时间（HR 0.45, 0.24至0.84）与较好的疾病特异性生存率相关。结论：年龄、疾病分期和完全切除是影响小肠类癌患者生存的独立预后因素。因此强调了实现R0切除的重要性。
Background: Previous studies of small bowel carcinoid tumours usually presented overall or relative survival. This study, in addition, evaluated disease-specific survival in a cohort of patients in a geographically defined population.Methods: Patients diagnosed with carcinoid of the jejunum or ileum in Jonkoping County between 1960 and 2005 were eligible for inclusion. Available tumour specimens were re-examined to confirm the diagnosis. Medical records and pathology reports were reviewed in detail.Results: A total of 145 patients were included in the study. One hundred and thirty-five patients underwent surgery in connection with the diagnosis. Resection was considered complete (R0) in 74 patients (54.8 per cent). Only two localized tumours recurred, whereas no patient with distant metastases was cured. Patients with regional metastases who underwent R0 resection had a better survival than patients with incomplete resection (P = 0.005), and a majority of patients remained recurrence-free. Median overall survival was 7.2 years and median disease-specific survival 12.3 years. In multivariable analysis, age 61-74 years (hazard ratio (HR) 3.78, 95 per cent confidence interval 1.86 to 7.68), age 75 years or more (HR 3.96, 1.79 to 8.74), distant metastases (HR 14.44, 1.59 to 131.36) and incomplete tumour resection (HR 2.71, 1.11 to 6.61) were associated with worse disease-specific survival. Later time period of diagnosis (HR 0.45, 0.24 to 0.84) was associated with better disease-specific survival.Conclusion: Age, disease stage and complete resection were identified as independent prognostic factors for survival in patients with small bowel carcinoid tumours. The importance of achieving R0 resection is therefore emphasized.