直肠神经内分泌瘤:它们可以观察吗?
Sarah P Kramer1, Celsa Tonelli2, Zaid Abdelsattar3
1Loyola University Chicago, Stritch School of Medicine, Maywood, IL; Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY. Electronic address: http://www.twitter.com/sarahpkMD.
Surgery
|September 4, 2023
概括
对于第1阶段的直肠神经内分泌瘤,预期管理是一个可行的选择. 然而,对于2/3阶段的疾病,与预期管理相比,局部切除提供了更好的生存结果.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
背景情况:
- 关于直肠神经内分泌瘤的最佳管理策略的数据有限.
- 机构系列往往不足以比较预期管理,局部切除和彻底切除.
研究的目的:
- 为了比较预期管理,局部切除和非转移性直肠神经内分泌瘤的彻底切除的疗效.
- 确定影响治疗决策和患者结果的因素.
主要方法:
- 利用国家癌症数据库 (2004-2019) 对非转移性直肠神经内分泌瘤患者.
- 采用多变量回归和考克斯建模来确定与预期管理和死亡率相关的因素.
- 通过使用卡普兰-梅尔分析进行1:1:1的倾向分数匹配,以比较期望管理,局部切除和激光切除队列之间的结果.
主要成果:
- 总共有6,316名患者被分析;83%接受了局部切除,9.5%的彻底切除,8%的预期管理.
- 预期的管理与黑人种族,政府保险和较小的瘤大小 (<2.0厘米) 有关.
- 彻底切除导致更长的住院时间和比局部切除更高的再入院率. 对于第一阶段的疾病,没有观察到生存率的差异. 2/3阶段的疾病显示,与预期管理相比,局部切除或彻底切除的生存率有所改善.
结论:
- 预期管理是第1阶段直肠神经内分泌瘤的合适方法.
- 推局部切除作为第二阶段和第三阶段直肠神经内分泌瘤的主要治疗方法.
- 这项研究提供了基于证据的指导,根据疾病阶段来管理直肠神经内分泌瘤.
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