婚姻状态对结直肠神经内分泌肿瘤患者远期预后的影响

目的探讨婚姻状态与结直肠神经内分泌肿瘤患者远期预后的关系。方法 利用美国SEER数据库中1988至2011年间诊断为结直肠神经内分泌肿瘤(不包括阑尾)的病例回顾性分析婚姻状态与总因死亡(overall-cause mortality, OM)和肿瘤特异性死亡(cancer-specific mortality, CSM)的关系；应用单因素和多因素Cox分析婚姻状态(已婚,未婚和离异、分居、丧偶)对结直肠内分泌肿瘤远期预后的影响。结果 共入组2962例患者中,已婚组占60%,未婚组占14%,分居、离婚、丧偶(SDW)组占26%。多因素Cox回归分析表明,相比于已婚组及未婚组,SDW组的肿瘤特异性死亡(HR=1.15, P=0.038)和总因死亡(HR=1.19, P=0.002)均较高；相比于已婚组,未婚组总因死亡(HR=1.24, P=0.006)较高。结论 SDW患者有较高的CSM和OM；该风险独立于年龄、ENETS分期、肿瘤位置、就诊年份。提醒医务人员在这类患者诊治过程中应提供更多关注。

Influence of marital status on overall and cancer-specific mortality in patients with colorectal neuroendocrine neoplasm

Objective To investigate the relationship between marital status and prognosis of patients with colorectal neuroendocrine tumors. Methods The American Surveillance, Epidemiology, and End Results (SEER) database was used to analyze patients who were diagnosed with colorectal neuroendocrine tumors (not including the appendix) from 1998 to 2011. Univariate and multivariate Cox regression analyses were performed to test the relationship between marital status (married, unmarried, separated/divorced/widowed, SDW) and cancer-specific mortality (CSM) and overall mortality (OM). Results We identified 2962 patients and found that married patients accounted for 60%, unmarried patients accounted for 14%, separated/divorced/widowed (SDW) patients accounted for 26%. Multivariate Cox regression analysis showed that SDW patients presented with higher risk of CSM (HR=1.15, P=0.038) and OM (HR=1.19,P=0.002) compared to married patients and unmarried patients; similarly, unmarried patients had higher OM (HR=1.24, P=0.006) rate compared to married patients. Conclusion SDW patients have higher CSM and OM. After controlling age, ENETS-stage, primary site and year of diagnosis, SDW patients have a significantly higher risk of death. Consequently, more focused health care should be paid to these individuals in the management of colorectal neuroendocrine tumors.