胸腺神经内分泌肿瘤手术和术后放疗预后价值的评估：一项基于SEER数据库的倾向性匹配研 ...

胸腺神经内分泌肿瘤手术和术后放疗预后价值的评估：一项基于SEER数据库的倾向性匹配研究。

Evaluation of the prognostic value of surgery and postoperative radiotherapy for patients with thymic neuroendocrine tumors: A propensity-matched study based on the SEER database.

背景：应用SEER数据库评价手术和术后放疗（PORT）对原发性胸腺神经内分泌肿瘤（TNETs）的预后价值。

方法：采用1998～2015年TNET患者SEER资料进行回顾性研究。根据是否进行手术进行倾向性评分匹配（PSM）。采用多变量Cox回归分析评估预后对总生存率（OS）和肿瘤特异性生存率（CSS）的影响。

结果：3947例患者中，TNET 293例（7.4%），胸腺瘤2788例（70.6%），胸腺癌866例（21.9%）。与其他亚型相比，TNET患者年龄小，男性比例大，组织学分级好或中等，诊断时疾病分期高，更易发生区域性淋巴结转移。TNET的中位OS和CSS分别为82.9（95%可信区间74.3-91.4）和101.9（95%可信区间91.9-111.8）个月，明显短于胸腺瘤。在TNET患者的配对队列中，OS和CSS的多变量分析显示非手术组预后明显较差（P<0.001）。与全/根治性切除术相比，TNET患者行大块切除术的预后明显较差（P<0.05）。术后放疗对Masaoka Koga III-IV期TNET患者的OS和CSS有良好的影响；IIB期患者也观察到这种OS影响。

结论：TNETs极为罕见，预后相对较差。本研究揭示了在特定的TNET亚组中，完全手术切除的作用和术后放疗的良好效果。

Abstract

BACKGROUND:

The prognostic value of surgery and postoperative radiotherapy (PORT) for primary thymic neuroendocrine tumors (TNETs) was estimated using the SEER database.

METHODS:

This retrospective study used SEER data of TNET patients between 1998 and 2015. Propensity score matching (PSM) was performed according to whether surgery was performed. The prognostic effects on overall survival (OS) and cancer-specific survival (CSS) were evaluated using multivariate Cox regression.

RESULTS:

A total of 3947 patients were included: 293 (7.4%) TNET, 2788 (70.6%) thymoma, and 866 (21.9%) thymic carcinoma. Compared to other subtypes, TNET patients were younger, included a larger proportion of men, had a well or moderately differentiated histological grade, higher disease stage at diagnosis, and were more likely to have regional lymph node metastasis. The median OS and CSS for TNET were 82.9 (95% confidence interval 74.3-91.4) and 101.9 (95% confidence interval 91.9-111.8) months, respectively, significantly shorter than for thymomas. In the matched cohort of TNET patients, multivariate analysis of OS and CSS revealed a significantly poorer prognosis in the non-surgery group (P < 0.001). Compared to total/radical resection, TNET patients who underwent debulking resection had significantly inferior outcomes (P < 0.05). Postoperative radiotherapy favorably impacted OS and CSS in Masaoka-Koga stage III-IV TNET patients; this OS impact was also observed in stage IIB patients.

CONCLUSION:

TNETs are extremely rare with relatively dismal outcomes. This analysis revealed the role of complete surgical resection and the favorable effect of postoperative radiotherapy in specific TNET subgroups.

图4 Masaoka-Koga期（a，b）IIB和（c，d）III-IV期胸腺神经内分泌肿瘤（TNET）患者术后放疗（PORT）和未放疗患者的总体生存率和肿瘤特异性生存率。（红色）PORT和（蓝色）non-PORT

Figure 4 Overall and cancer-specific survival in Masaoka–Koga stage (a, b) IIB and (c, d) III–IV thymic neuroendocrine tumor (TNET) patients with and without postoperative radiotherapy (PORT). ( ) PORT and ( ) non-PORT

Wen J, Chen J, Chen D, Liu D, Xu X, Huang L, Cao J, Zhang J, Gu Y, Fan M, Chen Y. Evaluation of the prognostic value of surgery and postoperative radiotherapy for patients with thymic neuroendocrine tumors: A propensity-matched study based on the SEER database. Thorac Cancer. 2018 Dec;9(12):1603-1613. doi:10.1111/1759-7714.12868. Epub 2018 Oct 1. PubMed PMID: 30276969; PubMed Central PMCID: PMC6275836.