PO.CL01.15 · 临床研究
神经内分泌肿瘤患者中类癌性心脏病管理的生存趋势
Survival trends in the management of carcinoid heart disease among patients with neuroendocrine tumors
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：近20%被诊断为神经内分泌肿瘤（NET）的患者将发展为类癌综合征（CS），20-25%的CS患者将发展为类癌性心脏病（CHD）。在当今NET管理时代，发展为CHD的危险因素和预后变量尚缺乏。
目的：本研究的主要目的是描述CS患者发展为CHD的临床、实验室和影像学危险因素，并识别NET患者的生存预测因素。
方法：对2010年1月至2024年12月的高分化NET患者进行了单机构回顾性分析。采用Cox比例风险回归评估基线协变量与CHD发展（主要终点）及总生存（OS；次要终点）之间的关联。CHD定义为超声心动图上中度或重度三尖瓣反流，与既往研究一致。采用Kaplan-Meier法估计OS和CHD发展的生存曲线。p值0.05被视为具有统计学意义。
结果：我们识别并纳入270例NET患者。中位年龄64.5岁，52%为男性，5.6%被诊断为CHD。10%的患者存在CS（n=27），其中41%发展为CHD。最常见的原发肿瘤部位为肺（26%）、胰腺（17.4%）和小肠（16.2%）。在多变量分析中，右心室（RV）扩张也与更短的至CHD诊断时间相关（风险比[HR] 7.65，95% CI：1.03-56.78，p=0.047）。CHD的诊断与总体更高的住院次数以及全身或多模式治疗的使用相关。对于OS这一次要终点，CHD患者的中位OS为90.8个月，而整个NET队列的中位OS未达到。在扩展Cox模型中，CHD的发展独立地与更差的OS相关（HR 7.09；95% CI 1.84-27.40，p=0.004），突显了其在基线肿瘤因素之外的强预后影响。全身治疗的使用（HR 8.97；95% CI：1.78-45.25，p=0.0101）和高级别（G3）肿瘤与更差的OS相关（HR 6.92；95% CI：2.40-19.92，p<0.001）。
结论：在NET患者中，CHD的诊断、全身/多模式治疗的使用以及高级别肿瘤与更差的总生存相关。尽管CHD的发生率较低，密切监测以早期诊断和干预在这些患者的管理中仍至关重要。
查看英文原文 English abstract
Background: Nearly 20% of patients diagnosed with neuroendocrine tumors (NET) will develop carcinoid syndrome (CS), with 20-25% of CS patients developing carcinoid heart disease (CHD). The risk factors for developing CHD and prognostic variables in the current day of NET management are lacking.
Objectives: The main objectives of this study were to describe the clinical, laboratory, and imaging risk factors for developing CHD in CS patients, and to identify predictors of survival in NET patients.
Methods: A single-institution, retrospective analysis of patients with well-differentiated NET from January 2010 to December 2024 was conducted. Cox proportional hazard regression assessed the association between baseline covariates and CHD development (primary endpoint), and overall survival (OS; secondary endpoint). CHD was defined as moderate or severe tricuspid regurgitation on echocardiogram, consistent with prior studies. Survival curves for OS and CHD development were estimated using the Kaplan-Meier method. A p-value of 0.05 was considered statistically significant.
Results: We identified and included 270 patients with NET in the study. Median age was 64.5 years, 52% were male and 5.6% were diagnosed with CHD. CS was present in 10% of patients (n=27), and 41% of those with CS developed CHD. The most common primary tumor sites were
lung (26%), pancreas (17.4%), and small intestine (16.2%). On multivariable analysis, right ventricular (RV) dilation was also associated with shorter time to CHD diagnosis (hazard ratio [HR] 7.65, 95% CI: 1.03-56.78, p=0.047). The diagnosis of CHD was associated with a higher number of hospitalizations overall and the use of systemic or multimodal therapies.For the secondary endpoint of OS, median OS for patients with CHD was 90.8 months, while median OS was not reached for the full NET cohort. CHD development was independently associated with worse OS in extended Cox models (HR 7.09; 95% CI 1.84-27.40, p=0.004), highlighting its strong prognostic impact beyond baseline tumor factors. The use of systemic therapy (HR 8.97; 95% CI: 1.78-45.25, p=0.0101) and high-grade (G3) tumors were associated with worse OS (HR 6.92; 95% CI: 2.40-19.92, p<0.001).
Conclusion: Among patients with NET, the diagnosis of CHD, use of systemic/multimodal therapy, and high-grade tumors were associated with worse overall survival. Although the incidence of CHD is low, close monitoring for early diagnosis and intervention remain critical in the management of these patients.
利益披露 Disclosure
S. G. Jung, None..
R. Steinberg, None..
A. Xi, None..
J. Switchenko, None..
O. Alese, None.