Survival from malignant digestive endocrine tumors in England and Wales: A population-based study
Survival from malignant digestive endocrine tumors in England and Wales: A population-based study
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DOI：
10.1053/j.gastro.2007.01.006
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发表时间：
2007-03-01
期刊：
影响因子：
29.4
通讯作者：
Coleman, Michel Philippe
中科院分区：
文献类型：
--
作者：
Lepage, Come;Rachet, Bernard;Coleman, Michel Philippe
背景和目标：目前对恶性消化道内分泌肿瘤（MDET）患者的预后知之甚少，主要是因为其罕见性。方法：这些肿瘤的生存率已经在一个大的，明确的，全国性的人群中进行了评估。在1986年至1999年的14年期间，对英格兰和威尔士诊断和登记的所有患者进行了随访，直至2001年底。估计相对生存率，并对年龄、性别、时期、组织学和解剖部位的影响进行建模。结果：4104例MDET中，小细胞肿瘤占21.2%。所有MDET合并的5年和10年相对生存率分别为45.9%和38.4%。高分化肿瘤的5年生存率为56.8%，而小细胞肿瘤仅为5.2%（P <0.0001）。大肠肿瘤的生存率最高，食管肿瘤的生存率最低。在分化良好的胰腺肿瘤中，胰岛素瘤的5年相对生存率为49.2%，胃泌素瘤为39.9%，胰高血糖素瘤为17.1%，类癌为26.3%，无功能肿瘤为29.3%。社会经济群体之间的生存率没有差异。1986年至2001年期间，五年生存率没有改善。女性和年轻患者的生存率较高。性别、年龄和解剖部位是独立的预后因素。结论：一般人群中MDET患者的预后比小型医院病例系列报告的预后差得多。预后因肿瘤分化、解剖部位和组织学类型而异。早期诊断是困难的;新的治疗选择似乎是改善预后的最佳方法。
Background & Aims: Little is known about the prognosis of patients with malignant digestive endocrine tumors (MDETs), primarily because of their rarity. Methods: Survival from these tumors has been evaluated in a large, well-defined, national population. All patients diagnosed and registered in England and Wales during the 14-year period from 1986 to 1999 were followed up for vital status to the end of 2001. Relative survival was estimated and the impact of age, sex, period, histology, and anatomic site modeled. Results: Among 4104 cases of MDETs, 21.2% were small cell tumors. Relative survival for all MDETs combined was 45.9% at 5 years and 38.4% at 10 years. Five-year survival was 56.8% for well-differentiated tumors but only 5.2% for small cell tumors (P < .0001). Survival was highest for large bowel tumors and lowest for esophageal tumors. Among well-differentiated pancreatic tumors, 5-year relative survival was 49.2% for insulinomas, 39.9% for gastrinomas, 17.1% for glucagonomas, 26.3% for carcinoid tumors, and 29.3% for nonfunctioning tumors. There was no difference in survival between socioeconomic groups. Five-year survival did not improve between 1986 and 2001. Survival was higher for women and for younger patients. Gender, age at diagnosis, and anatomic site were independent prognostic factors. Conclusions: The prognosis of patients with MDETs in the general population is considerably worse than is often reported from small hospital case series. Prognosis varies with tumor differentiation, anatomic site, and histologic type. Early diagnosis is difficult; new therapeutic options appear to represent the best approach to improved prognosis.