作者：廖述文1，詹洁群2，刘楚天1，区栋财1，温敏杰1

单位：1.广州市第一人民医院南沙医院 普外科， 广东 广州 511457;  2.广州市第一人民医院南沙医院 体检中心， 广东 广州 511457

Authors: Liao Shuwen1，Zhan Jiequn2 , Liu Chutian1, Ou Dongcai1, Wen Minjie1

Unit: 1.Department of General Surgery，Nansha Hospital of Guangzhou First People's Hospital，Guangzhou 511457， Guangdong，China;  2.Medical Examination Center，Nansha Hospital of Guangzhou First People's Hospital，Guangzhou 511457， Guangdong，China

摘要：

目的 探讨阑尾腺癌、杯状细胞类癌的临床病理特征，并分析其预后因素。方法 收集监测、流行病学、最终结果（SEER）数据库中2010年至2015年阑尾腺癌、杯状细胞类癌术后患者总共320例，分析比较阑尾腺癌组、阑尾杯状细胞类癌组间的临床病理资料，并分析其预后因素的差异。结果 阑尾腺癌、阑尾杯状细胞类癌术后患者各组肿瘤特征中存在明显差异。阑尾腺癌与阑尾杯状细胞类癌相比，在种族、年龄、肿瘤AJCC分期、临床TNM分期、手术方式、淋巴结清扫个数、肿瘤大小、肿瘤分化程度方面，两组比较差异有统计学意义（P<0.05）；在男女性别比较差异无统计学意义（P>0.05）。阑尾腺癌5年总生存（OS）率为58.7%，阑尾杯状细胞类癌术后5年OS率为84.4%，阑尾腺癌OS率较阑尾杯状细胞类癌低，差异具有统计学意义（P<0.05）。但亚组分析显示在肿瘤AJCC分期Ⅰ期（P=0.408）、Ⅲ期（P=0.628）、Ⅳ期（P=0.136）、淋巴结转移阳性、高分化（P=0.236）时，阑尾腺癌、阑尾杯状细胞类癌OS对比差异无统计学意义。Ⅱ期阑尾杯状细胞类癌OS要优于阑尾腺癌（P<0.05）；淋巴结转移阴性时阑尾杯状细胞类癌OS要优于阑尾腺癌（P<0.05）；而中分化（P=0.001）、低分化（P=0.007）阑尾杯状细胞类癌OS均优于阑尾腺癌。多因素Cox回归分析显示，肿瘤AJCC分期是阑尾杯状细胞类癌的独立预后预后危险因素；而肿瘤AJCC分期、淋巴结清扫个数是阑尾腺癌患者的独立预后危险因素。结论 阑尾腺癌较阑尾杯状细胞类癌OS低，且在年龄、肿瘤AJCC分期、肿瘤分化程度临床病理方面表现差。但不同分期、不同分化程度、不同淋巴结转移状态的阑尾腺癌及阑尾杯状细胞类癌患者术后表现出不完全一致的生存差异，可能受多方面的临床病理因素影响所致，且两者术后的危险因素也不完全一致。

关键词：阑尾肿瘤； 预后； 阑尾腺癌； 阑尾杯状细胞类癌； SEER 数据库

Abstract：

Objective To investigate the clinicopathological features of appendix adenocarcinoma and goblet cell carcinoid，and to analyze the prognostic factors. Method A total of 320 postoperative patients with appendiceal adenocarcinoma and goblet cell carcinoid from 2010 to 2015 were collected from the surveillance，epidemiology，and end results（SEER） database. The clinicopathological data of the two groups were analyzed and compared，and the differences in prognostic factors were analyzed. Result There were significant differences in tumor characteristics among groups of patients with adenocarcinoma of appendix and goblet cell carcinoid of appendix after operation. Compared with appendix goblet cell carcinoid ，there were statistically significant differences between the two groups in race，age，AJCC stage，clinical TNM stage， surgical method，number of lymph node dissection，tumor size and degree of tumor differentiation （P<0.05）. There was no significant difference between male and female （P>0.05）. The 5-year overall survival rate of appendix adenocarcinoma was 58.7%，and the 5-year OS of appendix goblet cell carcinoid was 84.4%. The overall survival rate of appendix adenocarcinoma was lower than that of appendix goblet cell carcinoid，and the difference was statistically significant（P<0.05）. However，subgroup analysis showed that there was no significant difference in OS between appendix adenocarcinoma and appendix goblet cell carcinoid in AJCC stage Ⅰ （P=0.408），STAGE Ⅲ（P=0.628），stage Ⅳ（P=0.136），positive lymph node metastasis and high differentiation （P=0.236）. The OS of stage Ⅱ appendix goblet cell carcinoid was better than that of appendix adenocarcinoma （P <0.05）. The OS of appendix goblet cell carcinoid was better than that of appendix adenocarcinoma when lymph node metastasis was negative （P<0.05）. The OS of the moderately differentiated （P=0.001） and poorly differentiated （P=0.007） appendiceal goblet cell carcinoid was better than that of appendiceal adenocarcinoma. Multivariate Cox analysis showed that AJCC stage was an independent prognostic risk factor for appendix goblet cell carcinoid. AJCC stage and number of lymph nodes were independent prognostic risk factors for patients with appendicular adenocarcinoma. Conclusion The overall survival rate of appendiceal adenocarcinoma is lower than that of appendiceal goblet cell carcinoid，and the clinicopathological features of age，AJCC stage，and tumor differentiation are worse. However，patients with appendiceal adenocarcinoma and appendiceal goblet cell carcinoid with different stages，degrees of differentiation and lymph node metastasis showed inconsistent survival differences after surgery，which may be influenced by various clinicopathological factors，and their postoperative risk factors are not completely consistent.

Key Words:  Appendiceal tumor; Prognosis; Appendix adenocarcinoma; Appendix goblet cell carcinoid; SEER database