83例淋巴结阴性直肠神经内分泌肿瘤的临床病理特征

目的:探讨淋巴结阴性直肠神经内分泌肿瘤(rectal neuroendocrine neoplasms,R-NENs)的临床病理特征。方法:回顾性分析2012年12月至2019年12月中日友好医院83例淋巴结阴性R-NENs患者的临床病理资料,并定期随访。结果:83例患者中男性49例(59.0%)、女性34例(41.0%);平均年龄(43.3±11.4)岁;61例(75.5%)患者主要因非特异性症状就诊;肿瘤单发75例(90.4%);肿瘤平均直径为(0.8±0.7)cm;主要浸润黏膜层及黏膜下层80例(96.4%);病理分级以G1为主,共65例(78.3%),Ki-67指数平均值为(2.1±1.7)%;肿瘤分期Ⅰ期78例(94.0%)。免疫组织化学法检测CgA阳性29例(34.9%)。治疗方式使用内镜下切除67例(80.7%),手术16例(19.3%)。中位随访时间24(3～90)个月,5年生存率100%,2例(2.4%)复发。肿瘤复发与Ki-67阳性指数具有显著相关性(P=0.025);肿瘤浸润深度与肿瘤直径具有相关性(P=0.030)。Kaplan-Meier法分析得出治疗方式、肿...

Clinicopathological characteristics of 83 lymph node-negative rectal neuroendocrine tumors

  Objective  To explore the clinicopathological characteristics of lymph node-negative rectal neuroendocrine neoplasms (RNENs).  Methods  We retrospectively analyzed and regularly followed up the clinical and pathological data of 83 patients with lymph node-negative rectal NENs treated at China-Japan Friendship Hospital between December 2012 to December 2019.  Results  Among the 83 patients, 49 (59%) were male and 34 (41%) were female with an average age of (43.3±11.4) years. Of the patients, 61 (75.5%) were mainly treated for nonspecific symptoms, 75 (90.4%) had a single tumor with an average size of (0.8±0.7) cm, 80 (96.4%) showed tumor infiltration into the mucosal and submucosal layers, and 65 (78.3%) predominantly had tumors of pathological grade G1. The average Ki-67 index was (2.1±1.7)%, with 78 (94%) patients having stage I tumors. Twenty-nine (34.9%) patients showed CgA positivity on immunohistochemical analysis. As for treatment, 67 (80.7%) patients underwent endoscopic resection, and 16 (19.3%) patients underwent surgery. The median follow-up time was 24 (3-90) months, with a 100% 5-year survival rate and relapse in 2 (2.4%) patients. Tumor recurrence was significantly correlated with the Ki-67 positive index (P=0.025), and tumor infiltration depth was correlated with the tumor diameter (P=0.03). Kaplan-Meier analysis showed that different treatment mode and tumor grade on prognosis and recurrence was statistically significant (Log-rank P=0.031, 0.001).  Conclusion  Lymph node-negative rectal neuroendocrine neoplasms with a diameter >1 cm infiltrate the muscularis propria relatively easily and those ≤ 1 cm may also infiltrate the muscularis propria. It is recommended that all patients undergo ultrasound enteroscope (EUS) to determine the treatment choice. Endoscopic resection is the main treatment for lymph node-negative rectal neuroendocrine neoplasms. Patients with a high Ki-67 index are relatively prone to relapse after treatment.