术后辅助化疗在消化道神经内分泌癌中的临床研究

  目的  消化道神经内分泌癌（neuroendocrine carcinomas，NECs）是一种罕见的侵袭性肿瘤。对于无远处转移的患者，可选择根治性手术，但术后易出现复发转移，预后差。术后辅助化疗在NECs中的疗效尚不明确，缺乏相关临床研究数据，无标准治疗方案。本研究观察接受根治性手术的消化道NECs患者接受术后辅助化疗对比单纯手术与生存的相关性。  方法  回顾性分析2018年6月至2020年9月于郑州大学附属肿瘤医院接受根治手术的消化道NECs患者的临床病理资料。根据是否接受术后辅助化疗分为辅助化疗组和单纯手术组。辅助化疗组于术后4~6周开始接受至少2个周期以铂类为基础的化疗。主要研究终点为2年无病生存率（disease-free survival，DFS），次要研究终点为不同辅助化疗方案DFS。  结果  共筛选62例患者，其中男性52例（83.9%），女性10例（16.1%），中位年龄为65（38~84）岁。食管NECs为12例（19.3%），胃NECs为45例（72.6%），小肠和结直肠NECs为5例（8.1%）。38例（61.3%）患者接受了术后辅助化疗，其中21例采用依托泊苷联合铂类（EP）方案化疗，17例采用伊立替康联合铂类（IP）方案化疗。21例患者术后辅助治疗超过4个周期。24例（38.7%）患者接受了单纯手术治疗。术后辅助化疗组和单纯手术组2年DFS分别为58.7%和14.7%（P < 0.001）。多因素分析提示，对于淋巴结阳性的患者接受术后辅助化疗可明显提高生存获益（HR:6.403，95%CI:1.329~27.465，P=0.020）。  结论  在可切除的消化道NECs中，术后辅助化疗可降低术后复发转移风险，提高患者的无病生存获益，但辅助化疗方案的选择仍需进行深入的研究。 

Clinical observation of postoperative adjuvant chemotherapy for neuroendocrine carcinomas of the digestive tract

Objective:Neuroendocrine carcinomas(NECs)of the digestive tract are rare and show aggressive behavior.Radical surgery can be performed in patients with non-metastatic disease;however,rapid recurrence and metastasis often occur after surgery,leading to a poor clinical prognosis.The role of postoperative adjuvant chemotherapy(PAC)in these patients remains controversial.Moreover,clinical research data are lacking,and there is no recommended standard treatment.Therefore,this study aimed to determine whether PAC is associated with a survival benefit in patients with NECs of the digestive tract compared to surgical resection alone.Methods:Sixty-two patients who met the inclusion criteria between June 2018 and September 2020 were included in the study.We performed a retrospective analysis of patients with NECs of the digestive tract who underwent radical surgery;the patients were divided into two groups,the PAC group and postoperative observation(PO)group,according to whether they had received postoperative chemotherapy.At least two cycles of platinum-based chemotherapy were administered within 4-6 weeks post-surgery in patients who received PAC.The primary endpoint was the 2-year disease-free survival(DFS)rate.The secondary endpoint was the DFS rate with respect to different adjuvant chemotherapy regimens.Results:Of the 62 patients,52(83.9%)were male and 10(16.1%)were female;the median age was 65(range,38-84)years.Twelve patients had esophageal neuroendocrine carcinomas(19.3%),45 had stomach neuroendocrine carcinomas(72.6%),and five had small intestine and colorectal NECs(8.1%).Thirty-eight patients(61.3%)received PAC:21 patients(33.9%)received etoposide plus cisplatin and 17 patients(27.4%)received irinotecan plus cisplatin.More than four cycles of chemotherapy were administered to 21 patients.The PO group contained 24 patients(38.7%).The 2-year DFS rates in the PAC and PO groups were 58.7%and 14.7%,respectively(P<0.001).Multivariate analyses demonstrated that in patients with positive lymph nodes,PAC could significantly improve survival(P=0.020,HR:6.403,95%CI:1.329-27.465).Conclusions:Patients with neuroendocrine carcinomas of the digestive tract who underwent radical resection can experience improved DFS after PAC,which reduces the risk of recurrence and metastasis after surgery.However,the choice of PAC regimen needs to be verified in further studies.