Primary Gallbladder Neuroendocrine Tumors: Insights into a Rare Histology Using a Large National Database.
Primary Gallbladder Neuroendocrine Tumors: Insights into a Rare Histology Using a Large National Database.
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DOI：
10.1245/s10434-019-07440-6
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发表时间：
2019-10
影响因子：
3.7
通讯作者：
Hernandez JM
中科院分区：
文献类型：
--
作者：
Ayabe RI;Wach M;Ruff S;Martin S;Diggs L;Wiemken T;Hinyard L;Davis JL;Luu C;Hernandez JM
原发性胆囊神经内分泌肿瘤（NETs）是一种罕见的、知之甚少的癌症，即使在最大的三级转诊中心也很少遇到。因此，我们试图确定一个大的队列胆囊NET患者使用国家数据库，目的是确定所采用的治疗方式和生存与这些罕见的恶性肿瘤。在国家癌症数据库中识别原发性胆囊NETs患者，并记录其临床病理特征。对接受切除术的患者进行单变量对数秩生存分析。将发现有意义的参数输入多变量加速失效时间分析。在此背景下，生存比较包括在任何胃肠道部位接受NET切除术和胆囊腺癌切除术的患者。总体而言，确定了754例胆囊NET患者。患者主要为女性（n = 518，69%）、白色（n = 503，67%）、IV期疾病（n = 295，39%）和高级别病变（n = 312，41%）。大多数接受切除术（n = 480，64%），主要是单纯胆囊切除术（n = 431，90%），而少数接受多模式治疗（n = 145，21%）。在接受切除术的患者中，年龄较大（p = 0.001）、大细胞组织学（p = 0.012）和切缘阳性（p = 0.030）与总生存率较差独立相关。胆囊NETs患者的生存率高于胆囊腺癌患者（p = 0.001），但明显低于其他胃肠道部位NETs患者（p<0.001）。原发性胆囊NETs是侵袭性病变，其预后比其他胃肠道部位的NETs更差。年龄较大、切缘阳性和大细胞组织学与切除术后生存期缩短相关。
Primary gallbladder neuroendocrine tumors (NETs) are rare, poorly understood cancers infrequently encountered at even the largest of tertiary referral centers. We therefore sought to identify a large cohort of patients with gallbladder NETs using a national database, with the aim of defining treatment modalities employed and survival associated with these uncommon malignancies. Patients with primary gallbladder NETs were identified in the National Cancer Database, and clinicopathologic characteristics were recorded. A univariate log-rank survival analysis was completed for patients who underwent resection. Parameters found to be significant were entered into a multivariate accelerated failure time analysis. For context, survival comparisons were included for patients who underwent resections for NETs at any gastrointestinal site and for gallbladder adenocarcinoma. Overall, 754 patients with gallbladder NETs were identified. Patients were predominantly female (n = 518, 69%), White (n = 503, 67%), presented with stage IV disease (n = 295, 39%) and had high-grade lesions (n = 312, 41%). The majority underwent resection (n = 480, 64%), primarily simple cholecystectomy (n = 431, 90%), whereas a minority received multimodal therapy (n = 145, 21%). Among patients who underwent resection, older age (p = 0.001), large cell histology (p = 0.012), and positive margins (p = 0.030) were independently associated with worse overall survival. Patients with gallbladder NETs had improved survival relative to those with gallbladder adenocarcinoma (p = 0.001), but significantly worse survival than patients with NETs from other gastrointestinal sites (p<0.001). Primary gallbladder NETs are aggressive lesions that carry a worse prognosis than NETs of other gastrointestinal sites. Older age, positive margins, and large cell histology are associated with abbreviated survival after resection.
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影响因子：
0.8
作者：
Adachi T;Haraguchi M;Irie J;Yoshimoto T;Uehara R;Ito S;Tokai H;Noda K;Tada N;Hirabaru M;Inoue K;Minami S;Eguchi S
通讯作者：
Eguchi S
影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
2.5
作者：
Duffy, A.;Capanu, M.;O'Reilly, E. M.
通讯作者：
O'Reilly, E. M.
影响因子：
28.4
作者：
Dasari, Arvind;Shen, Chan;Yao, James C.
通讯作者：
Yao, James C.
影响因子：
1.6
作者：
Kutting, Fabian;Schmidt, Matthias;Steffen, Hans-Michael
通讯作者：
Steffen, Hans-Michael