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结直肠黏液腺癌和非黏液腺癌的临床病理特征及预后:一项基于监测、流行病学和最终结果(SEER)数据库的人群研究

Clinicopathological characteristics and prognosis of colorectal mucinous adenocarcinoma and nonmucinous adenocarcinoma: a surveillance, epidemiology, and end results (SEER) population-based study.

作者信息

Li Zhi-Ping, Liu Xin-Yi, Kao Xiao-Ming, Chen Yi-Tian, Han Si-Qi, Huang Meng-Xi, Liu Chao, Tang Xin-Yi, Chen Yan-Yan, Xiang Dan, Huang Ya-Di, Lei Zeng-Jie, Chu Xiao-Yuan

机构信息

Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, China.

Department of Radiology, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen 518000, China.

出版信息

Ann Transl Med. 2020 Mar;8(5):205. doi: 10.21037/atm.2020.01.52.

Abstract

BACKGROUND

Mucinous adenocarcinoma (MC) is a rare histological subtype of colorectal adenocarcinoma. Previous studies investigating the prognosis of MC have conflicting results and the proper treatment of MC remains unclear.

METHODS

This retrospective study presents the clinicopathological characteristics and prognosis of MC. This cohort study collected data from April 1 through August 01, 2018. This study used data on 107,735 patients with nonmucinous adenocarcinoma (NMC) and 9,494 with MC between 2009 and 2013 from the Surveillance, Epidemiology, and End Results program (SEER). Clinicopathological features were analyzed by chi-square test and survival curves by the Kaplan-Meier method. We used propensity score matching (PSM) to account for potential bias. Logistic regression and Cox proportional hazards models were used to compare and calculate adjusted risks of MC death.

RESULTS

MC was more frequent in patients with older age, large tumor size and moderate tumor grade compared with NMC (P<0.001). Five-year survival was lower for MC patients than NMC patients (P<0.001). Older age, later tumor node metastasis (TNM) stage and multiple tumors indicated a poorer prognosis while surgery gave better survival outcomes [hazard ratio (HR) =0.38; 95% confidence interval (CI), 0.33 to 0.44; P<0.001]. Younger age, left-side colon location and early disease stage were associated with better survival after surgery (P<0.001).

CONCLUSIONS

Age, TNM stage, tumor number and treatment were indicators of prognosis and surgery gave better survival for MC patients compared with those without surgery. Our study contributes to their clinical treatment.

摘要

背景

黏液腺癌(MC)是结直肠癌中一种罕见的组织学亚型。既往关于MC预后的研究结果相互矛盾,且MC的恰当治疗仍不明确。

方法

这项回顾性研究呈现了MC的临床病理特征及预后情况。该队列研究收集了2018年4月1日至8月1日的数据。本研究使用了监测、流行病学和最终结果计划(SEER)在2009年至2013年间107735例非黏液腺癌(NMC)患者和9494例MC患者的数据。通过卡方检验分析临床病理特征,采用Kaplan-Meier法绘制生存曲线。我们使用倾向得分匹配(PSM)来处理潜在偏倚。采用逻辑回归和Cox比例风险模型比较并计算MC死亡的调整风险。

结果

与NMC相比,MC在年龄较大、肿瘤体积较大和肿瘤分级中等的患者中更为常见(P<0.001)。MC患者的5年生存率低于NMC患者(P<0.001)。年龄较大、肿瘤淋巴结转移(TNM)分期较晚和多原发肿瘤提示预后较差,而手术可带来更好的生存结局[风险比(HR)=0.38;95%置信区间(CI),0.33至0.44;P<0.001]。年龄较小、肿瘤位于左侧结肠以及疾病分期较早与手术后更好的生存相关(P<0.001)。

结论

年龄、TNM分期、肿瘤数量和治疗是预后指标,与未接受手术的患者相比,手术可使MC患者获得更好的生存。我们的研究有助于其临床治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73d2/7154470/f7f2f357bfeb/atm-08-05-205-f1.jpg

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