Consideration of Age Is Necessary for Increasing the Accuracy of the AJCC TNM Staging System of Pancreatic Neuroendocrine Tumors
Consideration of Age Is Necessary for Increasing the Accuracy of the AJCC TNM Staging System of Pancreatic Neuroendocrine Tumors
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为了提高胰腺神经内分泌肿瘤 AJCC TNM 分期系统的准确性，需要考虑年龄
DOI：
10.3389/fonc.2019.00906
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发表时间：
2019-09-19
影响因子：
4.7
通讯作者：
Zhang, Yun
中科院分区：
文献类型：
--
作者：
Wang, Zhengshi;Jiang, Wenii;Zhang, Yun
目的：目前，胰腺神经内分泌肿瘤（pNET）的两个最常见的分期系统中，一个来自欧洲神经内分泌肿瘤学会（ENETS），另一个来自美国癌症联合委员会（AJCC）。患者和方法：患者回顾性地从监测流行病学和最终结果（SEER）数据库（2004年至2013年）中选择。使用限制性三次样条评价年龄对风险比（HR）的影响。使用一致性指数（C-index）确定分期系统的区分能力。结果：共有3，034例pNET患者纳入最终分析。60岁以下患者死亡风险随年龄增长沿着缓慢增加，而60岁以上患者死亡风险急剧上升，形成镜像L型生存曲线。在当前AJCC肿瘤-淋巴结-转移（TNM）分期系统中，IA和IB期之间未观察到统计学显著性（p = 0.105）。IIB期患者的OS甚至比IIA期患者更长，但无统计学显著性（p = 0.574）。III期患者的比例较小（2.7%）。在aTNM分期系统中，Ⅰ、Ⅱ A、Ⅱ B期患者的生存率差异有统计学意义（p < 0.001），Ⅲ期患者的比例从2.7%上升到25.7%。在未来的pNET分期系统中，年龄应被视为一个因素。
Purpose: Currently, of the two most common staging systems of pancreatic neuroendocrine tumors (pNETs) one is from the European Neuroendocrine Tumor Society (ENETS) and the other is from the American Joint Committee on Cancer (AJCC). However, there are imperfections in both these staging systems.Patients and methods: Patients were selected retrospectively from the Surveillance Epidemiology and End Results (SEER) database (2004 to 2013). The effect of age on the hazard ratio (HR) was evaluated using restricted cubic splines. The discriminatory power of the staging systems was determined using the concordance index (C-index).Results: A total of 3,034 patients with pNETs were included in the final analyses. The risk of death increased slowly along with age for patients under 60 years of age, but the risk of death rose sharply for those over 60 years of age, forming a mirrored L-shaped survival curve. In the current AJCC tumor-node-metastasis (TNM) staging system, no statistical significance was observed between stages IA and IB (p = 0.105). Patients with stage IIB even had longer OS than patients with IIA, although there was no statistical significance (p = 0.574). The proportion of stage III patients was small (2.7%). In the proposed aTNM staging system, significant survival differences could be observed among stage I, IIA, and IIB (p < 0.001) and the proportion of stage III rose from 2.7 to 25.7%.Conclusion: Our findings suggest that age has a critical influence on the survival of patients with pNETs. Age should be considered as a factor in future staging systems of pNETs.