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Endoscopic and surgical treatment of T1N0M0 colorectal neuroendocrine tumors: a population-based comparative study

医学 倾向得分匹配 危险系数 结直肠癌 置信区间 比例危险模型 内科学 人口 监测、流行病学和最终结果 结直肠外科 队列 肝病学 流行病学 腹部外科 外科 肿瘤科 癌症 癌症登记处 环境卫生
作者
Hanlong Zhu,Si Zhao,Chunmei Zhang,Kun Ji,Wei Wu,Linlin Yin,Haihao Yan,Jian Zhou,Ruiyi Tang,Lin Miao
出处
期刊:Surgical Endoscopy and Other Interventional Techniques [Springer Nature]
卷期号:36 (4): 2488-2498 被引量:11
标识
DOI:10.1007/s00464-021-08535-6
摘要

With the rapid advances in endoscopic technology, endoscopic therapy (ET) is increasingly applied to the treatment of small (≤ 20 mm) colorectal neuroendocrine tumors (NETs). However, long-term data comparing ET and surgery for management of T1N0M0 colorectal NETs are lacking. The purpose of this work was to compare overall survival (OS) and cancer-specific survival (CSS) of such patients with ET or surgery.Patients with T1N0M0 colorectal NETs were identified within the Surveillance Epidemiology and End Results (SEER) database (2004-2016). Demographics, tumor characteristics, therapeutic methods, and survival were compared. Propensity score matching (PSM) was used 1:3 and among this cohort, Cox proportional hazards regression models were performed to evaluate correlation between treatment and outcomes.Of 4487 patients with T1N0M0 colorectal NETs, 1125 were identified in the matched cohort, among whom 819 (72.8%) underwent ET and 306 (27.2%) underwent surgery. There was no difference in the 5-year and 10-year OS and CSS rates between the 2 treatment modalities. Likewise, analyses stratified by tumor size and site showed that patients did not benefit more from surgery compared with ET. Moreover, multivariate analyses found no significant differences in OS [Hazard Ratio (HR) = 0.857, 95% Confidence Interval (CI): 0.513-1.431, P = 0.555] and CSS (HR = 0.925, 95% CI: 0.282-3.040, P = 0.898) between the 2 groups. Similar results were observed when comparisons were limited to patients with different tumor size and site.In this population-based study, patients with lesions < 10 mm treated endoscopically had comparable long-term survival compared with those treated surgically, which demonstrates ET as an alternative to surgery in T1N0M0 colorectal NETs of < 10 mm. Further high-quality prospective studies are warranted to comprehensively evaluate the role of ET in patients with tumors 10 to 20 mm.
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