Palliative resection of the primary tumor in 442 metastasized neuroendocrine tumors of the pancreas: a population-based, propensity score-matched survival analysis
Palliative resection of the primary tumor in 442 metastasized neuroendocrine tumors of the pancreas: a population-based, propensity score-matched survival analysis
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DOI：
10.1007/s00423-015-1323-x
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发表时间：
2015-08-01
影响因子：
2.3
通讯作者：
Ulrich, Alexis
中科院分区：
文献类型：
--
作者：
Huettner, Felix J.;Schneider, Lutz;Ulrich, Alexis
对于无法治愈的IV期胰腺神经内分泌肿瘤（P-NET）患者，姑息性切除原发肿瘤是否会带来生存获益，目前仍存在争议。本研究的目的是评估无法治愈的IV期P-NET患者的原发肿瘤姑息性切除是否对生存有影响。在2004年至2011年监测、流行病学和最终结果数据库中登记的IV期P-NET患者被确定。切除转移灶者排除在外。通过风险调整的Cox比例风险回归分析和倾向评分匹配分析，比较了接受和未接受原发肿瘤切除术的患者的总体和癌症特异性生存率。共有442例IV期P-NET患者被确定，其中75例（17.0%）接受了姑息性原发肿瘤切除术。在未调整的多因素Cox回归分析中，后者在总生存期（死亡风险比[HR] = 0.41, 95%可信区间[CI] 0.25-0.66, p < 0.001）和癌症特异性生存期（死亡风险比[HR] = 0.41, 95% CI 0.25-0.67, p < 0.001）均有显著益处；倾向评分调整后，获益持续存在。这项基于人群的IV期P-NET患者分析提供了令人信服的证据，证明姑息性切除原发肿瘤与显著的生存获益相关。因此，最近的建议判断切除原发肿瘤是不可取的，并且伴随的趋势是减少对原发肿瘤的姑息性切除，这是有争议的。
There is an ongoing debate on whether palliative removal of the primary tumor may result in a survival benefit for patients with incurable stage IV pancreatic neuroendocrine tumors (P-NET). The objective of this study was to assess whether palliative resection of the primary tumor in patients with incurable stage IV P-NET has an impact on survival.Patients with stage IV P-NET registered in the Surveillance, Epidemiology, and End Results database between 2004 and 2011 were identified. Those undergoing resection of metastases were excluded. Overall and cancer-specific survival of patients who did and did not undergo resection of their primary tumor were compared by means of risk-adjusted Cox proportional hazard regression analysis and propensity score-matched analysis.A total of 442 stage IV P-NET patients were identified, of whom 75 (17.0 %) underwent palliative primary tumor resection. The latter showed a significant benefit in both overall survival (hazard ratio [HR] of death = 0.41, 95 % confidence interval [CI] 0.25-0.66, p < 0.001) and cancer-specific survival (HR of death = 0.41, 95 % CI 0.25-0.67, p < 0.001) in unadjusted multivariate Cox regression analysis; the benefit persisted after propensity score adjustment.This population-based analysis of stage IV P-NET patients provides compelling evidence that palliative resection of the primary tumor is associated with significant survival benefit. Thus, the recent recommendations judging resection of the primary as inadvisable and the accompanying trend towards fewer palliative resections of the primary tumor have to be contested.