| Background:Type 1 gastric neuroendocrine tumors(g-NETs)are associated with type A chronic atrophic gastritis(CAG),which have a good prognosis but a high recurrence rate.However,the current measures to prevent recurrence are still controversial.Aim:To observe the clinical efficacy of the Chinese herbal decoction SMLJ01 in the treatment of type 1 g-NETs.Materials and Methods:The study was conducted prospectively and retrospectively in Cancer Hospital Chinese Academy of Medical Sciences,The First Affiliated Hospital,Sun Yat-sen University,Beijing Friendship Hospital and China-Japan Friendship Hospital from 2012 to 2019.Patients with type 1 g-NETs were nonrandomly divided into the treatment group and control group after endoscopic treatment according to their wishes.The patients in the treatment group received oral administration of SMLJ01(interruptions of no more than 3 months per year and no more than 7 days per month)with follow-up every 6-12 months,while the patients in the control group received follow-up alone.The analysis of recurrence-free survival(RFS)was performed by the Kaplan-Meier method,and univariate analysis of risk factors was performed with the Cox proportional hazards regression model after treatment for at least 6 months.The follow-up continued until Oct 31,2019.Results:During a median follow-up period of 22 months(range:2-86 months),survival was 100%,and no metastases occurred.In this clinical observational study,type 1 g-NETs were more prevalent in women and were usually small(less than 1 cm)and multicentric.There were 82 patients in the treatment group(50 females),and 21 patients(25.6%)had recurrence after a median of 22 months.There were 54 patients in the control group(33 females),and 22 patients(40.7%)experienced recurrence after a median of 8 months.The difference in recurrence was statistically significant(P<0.01).The risk of recurrence in the treatment group was 0.38 times as much as that in the control group(95%Cl:0.20-0.70).In terms of improvements in symptoms,Post-prandial fullness,poor appetite,fatigue,and other discomforts are alleviated in most patients in the treatment group,while symptoms such as insomnia,abdominal discomfort,and dizziness are not improved.The symptom score of patients after taking the Chinese medicine was 19.5(10.3,28.0),which was significantly lower than the score before taking the Chinese medicine(31.5(19.3,38.0)).The difference was statistically significant(P<0.01).The univariate analysis identified that being treated with SMLJ01 was a protective factor against recurrence.The risk of recurrence in the control group was 2.64 times higher than that in the treatment group(95%CI:1.43-4.86,P=0.002).Multivariate analysis suggested that in addition to being treated with SMLJ01,age equal to or greater than 50 years was another protective factor against recurrence.The risk of recurrence at age?50 years was only 0.25 times as much as that at age<50 years(95%CI:0-0.23,P=0.009).However,no significant associations were found for sex,tumor size,number of lesions,depth of tumor invasion,histological grade,endoscopic therapy,or H.pylori infection(P>0.05).Conclusion:The Chinese herb SMLJ01,which soothes the liver,strengthens the spleen,increases acid and harmonizes the stomach,can prolong the recurrence time,reduce the recurrence rate and relieve the symptoms in patients with type 1 g-NETs. |
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