| Objective: The purpose of this study is to analyze the clinicopathological data of gastric neuroendocrine carcinoma,gastric adenocarcinoma with neuroendocrine differentiation and gastric adenocarcinoma by the method of propensity score matching(PSM),and evaluate their clinical characteristics and prognostic factors,to provide reference for clinical work.Methods: This study collected patients with gastric adenocarcinoma,gastric neuroendocrine carcinoma or gastric adenocarcinoma with neuroendocrine differentiation and underwent radical surgery in the First Affiliated Hospital of Anhui Medical University from January 2012 to October 2017.The above three groups were matched in pairs(including gastric neuroendocrine carcinoma vs gastric adenocarcinoma,gastric adenocarcinoma with neuroendocrine differentiation vs gastric adenocarcinoma,and gastric neuroendocrine carcinoma vs gastric adenocarcinoma with neuroendocrine differentiation)by using PSM.Comparison of categorical variables using chi-square test.Survival analysis was performed by Kaplan-Meier method and log-rank test.Cox risk proportional regression model was used for univariate and multiple analysis.The definition of P <0.05 is statistically significant.All statistical analyses were performed using R.Results: A total of 2,073 patients were included,including 1,839 cases of gastric adenocarcinoma,149 cases of gastric adenocarcinoma with neuroendocrine differentiation,and 85 cases of gastric neuroendocrine carcinoma.Before PSM,compared with the adenocarcinoma,the adenocarcinoma with neuroendocrine differentiation was more common at the cardia/fund(P <0.001),the tumor size was larger(P <0.01),and the T stage(P =0.001),N stage(P <0.001),and TNM stage(P=0.001)were later.And neuroendocrine carcinoma was more common in the cardia/fundus(P <0.001),larger in size(P <0.01),more prone to nerve invasion(P<0.01)and vascular invasion(P =0.001),and later in T stage(P <0.01)and TNM stage(P <0.05).There was no significant difference in the clinicopathologic characteristics between adenocarcinoma with neuroendocrine differentiation and neuroendocrine carcinoma.After PSM,the clinicopathologic characteristics were not statistically different among the groups.Before PSM,there were statistical differences in overall survival(OS)and disease-free survival(DFS)between adenocarcinoma and adenocarcinoma with neuroendocrine differentiation(OS,P <0.001;DFS,P <0.001).After PSM,there was no significant difference in OS and DFS between the two groups(OS,P =0.55;DFS,P =0.35).The OS and DFS of adenocarcinoma and neuroendocrine cancer before and after PSM were significantly different(before PSM: OS,P <0.001;DFS,P <0.001;after PSM: OS,P <0.05;DFS,P <0.05).There was no statistical difference in OS and DFS between adenocarcinoma with neuroendocrine differentiation and neuroendocrine carcinoma before and after PSM(before PSM: OS,P =0.08;DFS,P =0.15;after PSM: OS,P =0.18;DFS,P =0.28).Multivariate analysis showed that gastric adenocarcinoma with neuroendocrine differentiation(relative to gastric adenocarcinoma)was not an independent risk factor for DFS(P =0.359),while tumor size,T stage and N stage were independent risk factors for DFS in the gastric adenocarcinoma and gastric adenocarcinoma with neuroendocrine differentiation group.Gastric adenocarcinoma(relative to gastric neuroendocrine carcinoma)was associated with increased DFS(HR,0.61;95% confidence interval,0.42-0.88;P <0.01),and T stage and N stage were independent risk factors for DFS in the gastric adenocarcinoma and gastric neuroendocrine carcinoma group.Gastric adenocarcinoma with neuroendocrine differentiation(compared with gastric neuroendocrine carcinoma)was not associated with DFS(P =0.706).T stage and N stage were independent risk factors for DFS in the gastric adenocarcinoma with neuroendocrine differentiation and gastric neuroendocrine carcinoma group.Conclusion: The general clinicopathological characteristics and prognosis of gastric adenocarcinoma with neuroendocrine differentiation are more similar to that of gastric neuroendocrine carcinoma,but the clinicopathological characteristics of gastric adenocarcinoma with neuroendocrine differentiation are significantly different from that of gastric adenocarcinoma.A more accurate preoperative and postoperative staging evaluation system is needed to accurately judge the prognosis.Gastric adenocarcinoma with neuroendocrine differentiation can be included in gastric neuroendocrine carcinoma,rather than gastric adenocarcinoma. |
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