| 117例胃神经内分泌肿瘤的临床病理特征和预后分析 |
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| 引用本文： | 王超,张靖宜,张振霞,孙琳,郭玉虹,邵兵,赵帅,孙燕.117例胃神经内分泌肿瘤的临床病理特征和预后分析[J].中国肿瘤临床,2019,46(5):239-246. |
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| 作者姓名： | 王超 张靖宜 张振霞 孙琳 郭玉虹 邵兵 赵帅 孙燕 |
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| 作者单位： | ①.天津医科大学肿瘤医院病理科，国家肿瘤临床医学研究中心，天津市肿瘤防治重点实验室，天津市恶性肿瘤临床医学研究中心（天津市300060） |
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| 基金项目： | 国家自然科学基金项目81472263国家自然科学基金项目81871990 |
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| 摘 要： | 目的 探讨胃神经内分泌肿瘤（neuroendocrine neoplasm，NEN）的临床病理特征和预后因素。 方法 收集天津医科大学肿瘤医院2011年3月至2017年12月收治的胃NEN病例，依据WHO（2010年版）分类复核，分析不同分类胃NEN临床病理特征，并进行生存分析。 结果 在117例胃NEN中，神经内分泌瘤（neuroendocrine tumor，NET）G1、NET G2、神经内分泌癌（neuroendocrine car? cinoma，NEC）和混合性腺神经内分泌癌（mixed adenoneuroendocrine carcinoma，MANEC）分别为13例（11.1%）、6例（5.1%）、57例（48.7%）和41例（35.1%）。胃NET G1/G2以多发肿物为主，肿物直径小，浸润深度浅，淋巴结和远处转移少见，确诊时分期较早；治疗方式包括胃镜黏膜下剥离术和根治性手术；大多数胃NET G1/G2包含NET的前驱病变；患者的预后较好。胃NEC和MANEC以单发肿物为主，肿物直径大，浸润深度深，淋巴结和远处转移多见，确诊时多为进展期；全部患者行手术切除，且大部分进行了辅助治疗。胃NEC以大细胞型和分化差为主，胃MANEC的神经内分泌和腺癌成分组成形式多样；胃NEC和MANEC患者的预后均较差，但影响两者无进展生存期和总体生存期的预后因素不同。 结论 胃NEN是一组异质性肿瘤，不同分类的胃NEN具有不同的临床病理特征，并且预后也存在差异。需要多中心大样本研究来完善胃NEN的分类，并探索预后相关因素。
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| 关 键 词： | 胃 神经内分泌肿瘤 分类 病理 预后 |
| 收稿时间： | 2018-12-17 |
Clinicopathological characteristics and prognostic factors of gastric neuroendocrine neoplasms: an analysis of 117 cases |
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| Affiliation: | ①.Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China②.Department of Hepatobiliary Surgery, Dongying People's Hospital, Dongying 257091, China |
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| Abstract: | Objective To explore the clinicopathological characteristics and prognostic factors of gastric neuroendocrine neoplasm (NEN). Methods Clinicopathological parameters and follow-up data collected from 117 patients with gastric NEN at Tianjin Medical University Cancer Institute and Hospital from March 2011 to December 2017 were reviewed, classified, and graded according to World Health Organization (WHO) 2010 classification. Clinicopathological characteristics of different types and grades of gastric NEN were compared and survival analysis was performed. Results Among the 117 cases confirmed as gastric NEN, this entire cohort comprised 13 cases (11.1%) of neuroendocrine tumor (NET) G1, 6 cases (5.1%) of NET G2, 57 cases (48.7%) of neuroendocrine carcinoma (NEC), and 41 cases (35.1%) of mixed adenoneuroendocrine carcinoma (MANEC). Gastric NET G1 and G2 typically consisted of multiple small tumors with shallow invasion and infrequent lymphatic and distant metastases at early stages at the time of diagnosis. The treatment of patients with gastric NET included endoscopic submucosal dissection and radical surgical resection. Precursor neuroendocrine lesions were detected in most cases. The patients with gastric NET G1 and G2 had a good prognosis. Gastric NEC and MANEC mostly consisted of single large tumors with deep infiltration, and common lymphatic and distant metastases at advanced stages when the diagnoses were confirmed. All the patients with gastric NEC and MANEC underwent surgical resection, and most received adjuvant therapy. Histopathological changes of gastric NEC were characterized by large cells and poorly differentiated tumors, while gastric MANEC had various forms of neuroendocrine and adenocarcinoma components. The prognosis of patients with gastric NEC and MANEC was poor for both; however, the predictors of progression-free survival and overall survival were different between gastric NEC and MANEC. Conclusions Gastric NEN are a group of heterogeneous tumors with different clinicopathological features and prognosis. More multicenter studies with large sample sizes are still needed to improve the classification of gastric NEN and explore the prognostic factors. |
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