基于SEER数据库回顾性分析食管神经内分泌癌的放疗价值

目的:基于SEER(surveillance,epidemiology,and end results)数据库分析放疗对食管神经内分泌癌（esophagus neuroendocrine carcinoma，ENEC）患者预后的影响，为这一罕见病理类型的食管癌患者提供临床决策参考。方法:通过SEER*Stat软件收集2004年至2015年间经病理确诊为原发性ENEC的202例患者资料。应用卡方检验分析放疗与患者各临床病理资料的关系，单因素COX风险回归模型得出影响ENEC患者肿瘤特异性生存（cancer special survival，CSS）和总生存（overall survival,OS）的因素，采用Kaplan-Meier法计算生存率并进行亚组分析。结果:卡方检验提示AJCC分期（P=0.001）、T分期（P=0.000）、远处转移（P=0.001）、手术（P=0.001）、化疗（P=0.000）与放疗均相关。单因素COX分析显示肿瘤部位、AJCC分期、T分期、远处转移、手术、化疗是影响ENEC患者CSS和OS的预后因素（P均<0.05）。放疗组患者的CSS（P=0.000）与OS（P=0.000）均优于未放疗组。Kaplan-Meier生存分析显示放疗组与未放疗组患者1、3、5年CSS分别为49.5% vs 27.8%、23.8%vs 7.9%、21.4% vs 3.0%。放疗组CSS优于未放疗组，差异有统计学意义（P=0.000）。进一步亚组分析显示放疗对肿瘤位于食管下1/3部（P=0.000）、未发生远处转移（P=0.009）、未接受手术（P=0.003）、接受化疗（P=0.000）的ENEC患者具有更好的生存获益。结论:放疗可改善ENEC患者的预后，尤其在下1/3部食管癌、未发生远处转移、未接受手术、接受化疗的患者中。

A retrospective analysis the value of radiotherapy in esophageal neuroendocrine carcinomas based on SEER database

Objective:To analyze the prognosis impact of radiotherapy on esophageal neuroendocrine carcinoma(ENEC) based on the National Cancer Institute's SEER(surveillance,epidemiology,and end results) database.It provides clinical decision-making reference for patients with this rare pathological type of esophageal cancer.Methods: We collected 202 cases with definite pathological diagnosis of ENEC from 2004 to 2015 by SEER*Stat software.Chi-square test was used to analyze the relationship between radiotherapy and clinical factors.Univariate Cox proportional hazards model was used to find out the factors that affect CSS and OS.Kaplan-Meier method was used for survival rate and subgroup analysis.Results:Chi-square test revealed that AJCC stage(P=0.001),T stage(P=0.000),distant metastasis(P=0.001),surgery(P=0.001),chemotherapy(P=0.000) were related to radiotherapy.Tumor site,AJCC stage,T-stage,distant metastasis,surgery and chemotherapy were prognostic factor influencing CSS and OS of ENEC patients(P＜0.05) in the univariate COX model.The CSS（P=0.000）and OS（P=0.000）of radiotherapy group were better than non-radiotherapygroup.Kaplan-Meier survival analysis showed that the 1,3 and 5 years CSS of radiotherapy group and non-radiotherapy group were respectively 49.5% vs 27.8%,23.8% vs 7.9%,21.4%vs 3.0%.The CSS of radiotherapy group was longer than non-radiotherapy group,and the difference between two groups was statistically significant(P=0.000).Subgroup analyses of radiotherapy found survival benefits in lower 1/3 site of esophagus(P=0.000),no distant metastasis(P=0.009),non-surgery(P=0.003),chemotherapy(P=0.000) groups.Conclusion:Radiotherapy could improve the prognosis of ENEC patients,especially in lower 1/3 site of esophagus,no distant metastasis,non-surgery,chemotherapy groups.