作者：张晓杰，赵东兵

单位：国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院 胰胃外科，北京 100021

Authors: Zhang Xiaojie, Zhao Dongbing

Unit: Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

摘要：

目的 探讨肝样腺癌的临床特征和预后的影响因素。方法 研究对象来自于美国国立癌症研究所数据库(Surveillance, Epidemiology and End Result database, SEER数据库)的肝样腺癌病例。分析患者的基本临床特征和预后影响因素。主要结局是总生存期(overall survival, OS),次要结局是癌症特异性生存期(cancer specific survival,CSS)。结果 共有139例肝样腺癌患者被纳入研究。肝样腺癌主要分布在男性(55.4%)、老年人(62.8%)、肺部(41.7%)和消化系统(39.6%)。所有患者的中位生存时间为4个月。1年和3年的OS和CSS分别为32.9%、36.1%和14.7%、17.3%。多变量分析显示远处转移(HR=2.477,95%CI:1.091～5.622,P=0.030),高T分期(T2,HR=4.444,95%CI:1.014～19.466,P=0.048;T4,HR=3.341,95%CI:1.007～11.080,P=0.049)是OS不良的独立影响因素,而原发部位手术治疗(HR=0.580,95%CI:0.345～0.975,P=0.040)是OS的独立保护性因素。此外,高T分期(T2,HR=8.058,95%CI:1.645～39.481,P=0.01;T4,HR=4.022,95%CI:1.052～15.375,P=0.042)是CSS的独立危险因素,而原发部位手术治疗(HR=0.556,95%CI:0.322～0.960,P=0.035)是CSS的独立保护因素。结论 肝样腺癌在老年人、男性、肺部和消化系统中更为常见。高T分期、远处转移和手术治疗是影响预后的独立因素。

关键词：肝样腺癌；SEER数据库；预后

Abstract：

Objective To explore the clinical and prognostic characteristics of hepatoid adenocarcinoma (HAC). Methods HAC cases from SEER databases were included in the study. The basic clinical characteristics and prognosis of the patients were analyzed. The primary outcome was overall survival (OS), and the secondary outcome was cancer-specific survival (CSS). Results A total of 139 HAC patients were eventually included in the study. Generally, HAC is mainly distributed in the males (55.4%), elderly (62.8%), lungs (41.7%) and digestive system (39.6%). All patients had a median survival time of 4 months. Specifically, the OS and CSS at 1 and 3 years were 32.9% , 36.1% , 14.7% , and 17.3% , respectively. Multivariate analysis showed distant metastasis (HR=2.477, 95% CI: 1.091-5.622, P=0.030), advanced T stage (T2, HR=4.444, 95% CI: 1.014-19.466, P=0.048; T4, HR =3.341, 95% CI: 1.007-11.080, P=0.049) were independent risk factors for poor OS, while primary site surgery (HR=0.580, 95% CI: 0.345-0.975, P=0.040) was protective factor of OS. In addition, advanced T stage (T2, HR=8.058, 95% CI: 1.645-39.481, P=0.01; T4, HR=4.022, 95% CI: 1.052-15.375, P=0.042) was independent unfavorable factor of CSS, while primary site surgery (HR=0.556, 95% CI: 0.322-0.960, P=0.035) was a favorable one. Conclusion HAC is more common in the elderly, males, lungs, and digestive system. Advanced T stage, distant metastasis, and surgical treatment are independent factors for prognosis.

Key Words: Hepatoid adenocarcinoma；Surveillance, Epidemiology, and End Results；Prognosis