胰腺神经内分泌癌的临床病理学特征与外科治疗

目的 探讨胰腺神经内分泌癌(pancreatic neuroendocrine carcinoma,PNEC)的临床病理学特征与外科治疗效果.方法 回顾性分析笔者所在医院2008年1月至2012年3月期间行手术治疗的31例PNEC患者的临床病理学特征与外科治疗效果.采用免疫组织化学SP法观察肿瘤嗜铬粒素A(CgA)、突触素(Syn)、白细胞分化抗原56 (CD56)、细胞角蛋白(CK)、血管内皮生长因子(VEGF)和增殖蛋白Ki-67的表达情况；采用log-rank检验比较根治性切除组与姑息性手术组患者生存情况之间的差异.结果 31例患者中行根治性切除者22例,行姑息性手术者9例.CgA、Syn、CD56、CK及VEGF的表达阳性率分别为64.52％ (20/31)、100％(31/31)、77.42％(24/31)、90.32％ (28/31)和90.32％ (28/31)；Ki-67表达阳性细胞所占百分比＜3％者占45.16％ (14/31),3％～20％者占22.58％ (7/31),＞20％者占32.26％ (10/31).根治性切除组患者的生存率及生存时间较姑息性手术组患者高和长(P＜0.001).结论 PNEC呈浸润性生长,低分化且高度恶性,应积极采取手术治疗以改善患者的预后.

Clinicopathologic Features and Surgical Treatment of Pancreatic Neuroendocrine Carcinoma

Objective To investigate the clinicopathologic features and effect of surgical treatment of pancreatic neuroendocrine carcinoma (PNEC).Methods Clinical data of 31 patients with PNEC treated from Jan.2008 to Mar.2012 in our hospital were analyzed,and the expressions of protein CgA,Syn,CD56,CK,VEGF,and Ki-67 were detected by immunohistochemical method.The differences of survival rate and time between radical excision group and palliative surgery group were analyzed by log-rank test.Results Of the 31 patients,22 patients received radical resection and 9 patients received palliative surgery.The positive expression rate of protein CgA,Syn,CD56,CK,and VEGF was 64.52% (20/31),100% (31/31),77.42% (24/31),90.32% (28/31),90.32% (28/31),respectively.According to the percentage of Ki-67 positive cells,14 (45.16%) patients expressed less than 3%,7 (22.58%) patients expressed between 3% and 20%,and 10 (32.26%)patients expressed more than 20%.The survival rate and time of radical resection group were significantly higher and longer than palliative surgery group (P<0.001).Conclusions PNEC is a high potential malignancy and demonstrates aggressive biological behavior.Radical resection can improve the prognosis of patients with PNEC.