Prognostic relevance of neuroendocrine differentiation in colorectal cancer: a population-based, propensity score matching study
Prognostic relevance of neuroendocrine differentiation in colorectal cancer: a population-based, propensity score matching study
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DOI：
10.1007/s00384-020-03708-6
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发表时间：
2020-07-28
影响因子：
2.8
通讯作者：
Chen, Zhikang
中科院分区：
文献类型：
--
作者：
Guo, Jianping;Zheng, Peilin;Chen, Zhikang
目的 神经内分泌分化（NED）可能作为结直肠癌的预后因素；然而，NED 的预后相关性仍存在争议。本研究的目的是确定 NED 是否影响结直肠癌患者的生存，同时探索其与其他临床病理特征的潜在相互作用。方法 使用监测、流行病学和最终结果数据库识别 2010 年至 2015 年期间患有原发性 I 至 IV 期结直肠腺癌的患者。本研究采用了Kaplan-Meier技术、Cox比例风险模型、倾向评分匹配和分层分析。结果共纳入94,291例患者（包括101例NED患者和94,190例无NED患者）。在单变量分析中，发现 NED 与显着较差的总生存率（死亡风险比 (HR) = 3.09，95% CI 2.42-3.95，P < 0.001）和癌症特异性生存率（死亡 HR = 3.77，95% CI 2.94-4.83，P < 0.001）相关。此外，在多变量和倾向评分分析中调整后，NED 仍与总生存率（死亡 HR = 1.84，95% CI 1.34-2.51，P < 0.001）和癌症特异性生存率（死亡 HR = 2.01，95% CI 1.45-2.79，P < 0.001）独立相关。此外，进一步分层分析表明，NED对生存的影响不受肿瘤部位、分化程度、T分期和远处转移状态的影响；然而，发现它与淋巴结转移有关。结论 NED 与结直肠癌患者的不良生存结果相关，尤其是淋巴结阳性的患者。
Purpose Neuroendocrine differentiation (NED) may serve as a prognostic factor in colorectal cancer; however, the prognostic relevance of NED remains controversial. The aim of the present study was to determine whether NED influenced the survival of patients in colorectal cancer while exploring its potential interactions with other clinicopathological features. Methods Patients with primary stage I to IV colorectal adenocarcinoma ranging between 2010 and 2015 were identified using the Surveillance, Epidemiology, and End Results database. The Kaplan-Meier technique, Cox proportional hazards model, propensity score matching, and stratification analyses were employed in this study. Results A total of 94,291 patients (including 101 patients with NED and 94,190 patients without NED) were included. In the univariable analyses, NED was found to be correlated with a significantly poorer overall survival (hazard ratio (HR) of death = 3.09, 95% CI 2.42-3.95,P< 0.001) and cancer-specific survival (HR of death = 3.77, 95% CI 2.94-4.83,P< 0.001). Moreover, NED remained independently correlated with overall survival (HR of death = 1.84, 95% CI 1.34-2.51,P< 0.001) and cancer-specific survival (HR of death = 2.01, 95% CI 1.45-2.79,P< 0.001) after adjusting in multivariable and propensity score analyses. Furthermore, further stratification analyses indicated that the influence of NED on survival was not affected by tumor location, differentiation, T stage, and distant metastasis status; however, it was found to be associated with lymph node metastasis. Conclusions NED is associated with poor survival outcomes among colorectal cancer patients, especially in those with positive lymph nodes.