Background

Current studies on the number of removed lymph nodes (LNs) and their prognostic value in small-bowel neuroendocrine tumors (SBNETs) are limited. This study aimed to clarify the prognostic value of removed LNs for SBNETs.

Methods

SBNET patients without distant metastasis from 2004 to 2017 in the SEER database were included. The optimal cutoff values of examined LNs (ELNs) and negative LNs (NLNs) were calculated by the X-tile software. Propensity score matching (PSM) was done to match patients 1:1 on clinicopathological characteristics between the two groups. The Kaplan-Meier method with log-rank test and multivariable Cox proportional-hazards regression model were used to evaluate the prognostic effect of removed LNs.

Results

The cutoff values of 14 for ELNs and 9 for NLNs could well distinguish patients with different prognoses. After 1:1 PSM, the differences in clinicopathological characteristics between the two groups were significantly reduced (all P > 0.05). Removal of more than one LN significantly improved the prognosis of the patients (P < 0.001). The number of lymphatic metastasis in the sufficiently radical resection group (SRR, 3.74 ± 3.278, ELN > 14 and NLN > 9) was significantly more than that in the insufficiently radical resection group (ISRR, 2.72 ± 3.19, ELN < 14 or NLN < 9). The 10-year overall survival (OS) of the SRR was significantly better than that of the ISRR (HR = 1.65, P = 0.001, 95% CI: 1.24–2.19).

Conclusion

Both ELNs and NLNs can well predict the OS of patients. Systematic removal of more than 14 LNs and more than 9 NLNs can increase the OS of SBNET patients.

中文翻译：

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切除的淋巴结对 M0 小肠神经内分泌肿瘤预后的作用：SEER 数据库的倾向评分匹配分析

 背景

目前关于小肠神经内分泌肿瘤（SBNET）中切除的淋巴结（LN）数量及其预后价值的研究有限。本研究旨在阐明去除 LN 对 SBNET 的预后价值。

 方法

纳入SEER数据库中2004年至2017年无远处转移的SBNET患者。通过 X-tile 软件计算检查 LN (ELN) 和阴性 LN (NLN) 的最佳截止值。进行倾向评分匹配（PSM）以将两组患者的临床病理特征进行1:1匹配。采用对数秩检验和多变量 Cox 比例风险回归模型的 Kaplan-Meier 方法评估切除淋巴结的预后效果。

 结果

ELN 的截止值是 14，NLN 的截止值是 9，可以很好地区分不同预后的患者。 1:1 PSM后，两组临床病理特征差异显着缩小（均P >0.05）。切除超过 1 个淋巴结可显着改善患者的预后（ P < 0.001）。充分根治性切除组（SRR，3.74±3.278，ELN>14和NLN>9）的淋巴转移数量明显多于未充分根治性切除组（ISRR，2.72±3.19，ELN<14或NLN<）。 9). SRR 的 10 年总生存率 (OS) 显着优于 ISRR（HR = 1.65， P = 0.001，95% CI：1.24–2.19）。

 结论

ELN和NLN都可以很好地预测患者的OS。系统性切除超过 14 个 LN 和超过 9 个 NLN 可以提高 SBNET 患者的 OS。