23例胃低分化神经内分泌癌的临床病理特点和预后分析

目的 探讨胃低分化神经内分泌癌的临床病理特点及其预后.方法 回顾分析复旦大学附属肿瘤医院腹部外科1996年1月至2007年12月收治的23例胃低分化神经内分泌癌的临床资料.结果 23例胃低分化神经内分泌癌占同期收治胃癌的0.52%.其中男18例,女5例,平均年龄62岁.22例为单发病灶,有16例肿瘤位于近端胃,肿瘤最大直径平均为6.8 cm;Ⅱ期3例,Ⅲ期12例,Ⅳ期8例.13例患者进行了根治切除,8例姑息切除,2例行探查和活检.21例切除的病灶中,18例（85.7%）有脉管浸润,16例（76.2%）有神经浸润,17例（81.0%）有淋巴结转移.全组患者随访3～63个月,平均生存期为17.7个月,1、2、5年生存率分别为47.8%、19.1%和4-3%.患者的生存时间与肿瘤的分期（P=0.014）和能否根治切除（P=0.001）有关;而与性别、年龄和肿瘤大小及位置无关（P〉0.05）.结论 胃低分化神经内分泌癌是胃恶性肿瘤中的少见病理类型,恶性程度高,预后差,肿瘤分期和能否根治切除是影响预后的重要因素.

Clinicopathological and prognostic analysis of 23 poorly differentiated neuroendocrine carcinomas of the stomach

Objective To evaluate the clinicopathological characteristics and prognosis of poorly differentiated neuroendocrine carcinoma of the stomach.Methotis Twenty-three poody differentiated neuroendocrine carcinomas of the stomach were treated in the Department of Abdominal Surgery at the Cancer Hospital, Fudan University between January 1996 and December 2007.Clinicopathological characteristics and survival data were analyzed.Results Poorly difierentiated neuroendoerine carcinomas of the stomach accounted for 0.52%of all the gastric carcinomas.The tumor occurred more often in males(18 of 23),older patients(mean age of 62 years),upper third of the stomach(16 of 24,one patient had more than one lesion)with large size(mean diameter of 6.8 cm).TNM stages were as follows:stage Ⅱ in 3 patients,stage Ⅲ in 12,and stage Ⅳ in 8.Thirteen patients underwent curative resection,while 8 underwent palliative resection and 2 others underwent exploratory laparotomy with biopsy.Of tlle 21 surgical resection specimens.vascular invasion was found in 18 patients (85.7%),perineural invasion in 16 patients(76.2%),and regional lymph node metastasis in 17 patients (81.0%).Follow up time ranged from 3 to 63 months.Mean overall survival time was 17.7 months.The 1-year,2-year,and 5-year survival rates were 47.8%,19.1%,and 4.3%,respectively.Statistically significant differences in survival curves were observed which were related to tumor staging and surgery type,but not related to gender,age,tulnor location,or diameter.Conclusions Poorly differentiatedneuroendocrine carcinomas of the stomach are rare and with poor prognosis.Tumor stage and surgjcal type have potential impact on survival.