Clinical Analysis of 15 Cases of Gallbladder Neuroendocrine Carcinoma and Comparison with Gallbladder Adenocarcinoma Using a Propensity Score Matching
Clinical Analysis of 15 Cases of Gallbladder Neuroendocrine Carcinoma and Comparison with Gallbladder Adenocarcinoma Using a Propensity Score Matching
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15例胆囊神经内分泌癌临床分析及与胆囊腺癌的倾向评分匹配比较
DOI：
10.2147/cmar.s227501
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发表时间：
2020-01-01
影响因子：
3.3
通讯作者：
Zhao, Hong
中科院分区：
文献类型：
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作者：
Yan, Shida;Wang, Yingyi;Zhao, Hong
目的探讨胆囊神经内分泌癌(GB-NEC)的临床病理特征及预后。对象与方法收集2009-2015年间在两个三级医学中心收治的胆囊腺癌(GB-ADC)和胆囊腺癌(GB-ADC)患者各15例。回顾分析GB-NEC的临床病理特征及预后危险因素。采用1：2倾向评分匹配的方法比较GB-NEC和GB-ADC的预后。结果GB-NEC患者的中位年龄为58.4岁(26~75岁)，男女之比为7：8。按2010年WHO分类，病理确诊为NECS 10例，MANEC 5例。TNM分期III期及以上者11例，内文分期IV期及以上者7例。GB-NEC的1、2、3年总生存率分别为60.0%、38.8%和31.1%，中位生存期为20.4个月。有淋巴结转移者的生存期明显短于无转移者(OS：10.4个月对26.0个月，p<；0.05)。因此，内文分期III的患者比内文分期IV的患者有更好的OS(p<；0.05)，但其他潜在的危险因素包括性别、年龄、临床症状、TNM分期、组织病理亚型和治疗等无统计学意义。倾向评分匹配后，15例GB-NEC患者和30例GB-ADC患者的基线变量无显著差异，生存分析显示GB-NEC患者预后较差(3年总生存率：31.1%vs63.8%，p<；0.01)。结论NIVIN分期有助于对预后不同的GB-NEC患者进行分类，淋巴结转移是影响OS预后的重要因素。倾向性评分分析显示，即使在相似的分期和治疗方式下，GB-NEC的OS仍比GB-ADC差。
Purpose This study aimed to investigate the clinicopathological features and prognosis of gallbladder neuroendocrine carcinoma (GB-NEC). Patients and Methods Fifteen patients with GB-NEC and 171 patients with gallbladder adenocarcinoma (GB-ADC) treated in two tertiary medical centers between 2009 and 2015 were included. The clinicopathological features and prognostic risk factors of GB-NEC were analyzed retrospectively. A propensity score matching in a 1:2 ratio was used to compare the prognosis of GB-NEC and GB-ADC. Results For patients with GB-NEC, the median age of patients was 58.4 years (range 26–75), with a M:F ratio of 7:8. Based on 2010 WHO classification, ten cases were pathologically confirmed as NECs and five cases as MANECs. For TNM staging, eleven patients were stage III or above; while for Nevin staging, seven patients were stage IV or above. The 1-, 2-, and 3-year overall survival (OS) of GB-NEC were 60.0%, 38.8% and 31.1%, respectively, and the median survival time was 20.4 months. Patients with lymph node metastasis had significantly shorter survival than those without (OS: 10.4 vs 26.0 months, p<0.05). Accordingly, patients of Nevin stage III had better OS than those of Nevin stage IV (p<0.05), but other potential risk factors including gender, age, clinical symptoms, TNM stage, histopathologic subtype and treatment showed no significance. After the propensity score matching, the baseline variables had no significant difference between 15 patients with GB-NEC and 30 patients with GB-ADC, survival analysis showed GB-NEC had worse prognosis (3-year overall survival rate: 31.1% vs 63.8%, p<0.01). Conclusion Nevin staging helps classify patients of GB-NEC with different prognosis and the lymph node metastasis is a strong negative prognostic factor for OS. The propensity score analysis revealed even with the similar stage and treatment, GB-NEC still had worse OS than GB-ADC.