PO.CL09.02 · 临床研究
基于原发部位的IV期黏液腺癌临床结局
Clinical outcomes of stage IV mucinous adenocarcinoma based on primary sites
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摘要 Abstract
中文摘要
背景：黏液腺癌（MAC）是一种少见的腺癌亚型，可发生于多个器官。其生物学特性和预后因部位而异，且支持IV期MAC治疗获益的证据有限。本研究比较了不同原发部位IV期MAC的临床特征和生存结局，重点关注肺MAC。
方法：从监测、流行病学和最终结果（SEER）17个登记处提取2000年至2021年的临床数据。纳入采用第七或第八版TNM分类初诊为IV期MAC的患者。分析四个主要原发部位：结直肠、肺、胰腺和胃。排除标准为原位腺癌、微浸润腺癌、I至III期以及生存信息缺失。采用Cox比例风险回归评估包括年龄、性别、肿瘤分期和社会经济因素在内的人口统计学和临床病理变量，以评估总生存的危险因素。采用Kaplan-Meier法和log-rank检验比较各部位间不同治疗的生存差异。
结果：共纳入1,036例患者：结直肠（n = 489）、肺（n = 160）、胰腺（n = 331）和胃（n = 56）。各部位中位年龄存在差异（p < 0.001），肺MAC发病年龄最大，且晚期淋巴结病变比例最高（p < 0.001）。生存随原发部位而异：与结直肠MAC相比，肺MAC（风险比[HR] 1.66；95%置信区间[CI] 1.31-2.11；p < 0.0001）和胃MAC（HR 1.64；95% CI 1.13-2.37；p = 0.009）结局更差，而胰腺MAC预后最差（HR 2.78；95% CI 2.36-3.29；p < 0.0001）。在多数部位，手术加化疗相比单纯化疗改善生存（结直肠，HR 0.38，p < 0.001；肺，HR 0.49，p = 0.024；胰腺，HR 0.66，p = 0.003）。此外，较高收入水平与更好的生存相关（HR 0.61；95% CI 0.44-0.85；p = 0.003）。
结论：IV期MAC显示出显著的部位特异性生存差异。肺MAC的结局优于胰腺MAC，尤其是在接受多模式治疗时。肿瘤相关的宏观/微观环境特征和分子谱可能是造成这些差异的原因。手术加化疗的获益在多数MAC中观察到。需要整合基因组和治疗相关数据的前瞻性研究来指导个体化管理。
查看英文原文 English abstract
Background: Mucinous adenocarcinoma (MAC) is an uncommon adenocarcinoma subtype that arises in multiple organs. Its biology and prognosis vary by site, and evidence supporting treatment benefit in stage IV MAC is limited. This study compared clinical features and survival outcomes of stage IV MAC across primary sites with emphasis on pulmonary MAC.
Methods: Clinical data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 17 registries from 2000 to 2021. Patients initially diagnosed with stage IV MAC using the seventh or eighth TNM classification were included. Four major primary sites were analyzed: colorectal, lung, pancreas, and stomach. Exclusions were adenocarcinoma in situ, minimally invasive adenocarcinoma, stage I to III, and missing survival information. Demographic and clinicopathologic variables including age, sex, tumor stage, and socioeconomic factors were assessed with Cox proportional hazard regression to evaluate risk factors for overall survival. Survival differences by treatment were compared across sites by Kaplan Meier lwith log-rank test.
Results: A total of 1,036 patients were included: colorectal (n = 489), pulmonary (n = 160), pancreas (n = 331), and stomach (n = 56). Median age differed across sites (p < 0.001), with pulmonary MAC presenting at the oldest age and showing the highest proportion of advanced nodal disease (p < 0.001). Survival varied by primary site: Compared with colorectal MAC, pulmonary MAC (hazard ratio [HR] 1.66; 95% confidence interval [CI] 1.31-2.11; p < 0.0001) and stomach MAC (HR 1.64; 95% CI 1.13-2.37; p = 0.009) had worse outcomes, while pancreatic MAC had the poorest prognosis (HR 2.78; 95% CI 2.36-3.29; p < 0.0001). Surgery plus chemotherapy improved survival compared with chemotherapy alone in most sites (colorectal, HR 0.38, p < 0.001; lung, HR 0.49, p = 0.024; pancreas, HR 0.66, p = 0.003). Additionally, Higher income level was associated with better survival (HR 0.61; 95% CI 0.44-0.85; p = 0.003).
Conclusions: Stage IV MAC shows marked site specific survival differences. Pulmonary MAC has more favorable outcomes than pancreatic MAC, particularly with multimodal therapy. Tumor related macro/microenvironmental features and molecular profiles may contribute to these differences. The benefit of surgery plus chemotherapy was observed in most MAC. Prospective studies that integrate genomic and treatment related data are needed to guide personalized management.
利益披露 Disclosure
W. Woo, None..
S. Kim, None..
J. Kim, None..
V. Lopez, None..
Y. Lee, None..
K. Chohan, None.