结直肠神经内分泌癌15例临床诊治分析

目的：探讨结直肠神经内分泌癌（neuroendocrine carcinoma，NEC）的临床特点和预后。方法回顾性分析我院2009年1月至2015年 1月间收治的15例结直肠神经内分泌癌患者的临床资料，并对患者临床一般资料、治疗方式、病理特点和预后进行统计分析。结果患者平均年龄（58．3±6．8）岁，中位病程6个月。主要临床症状为血便者9例（60％），排便习惯改变者10例（66．7％），腹部肿块1例（6．7％）。术前肠镜误诊率为26．7％（4／15）。总的手术根治率为46．7％（7／15）。术后大体病理溃疡型9例（60％），隆起型6例（40％）；小细胞NEC 10例（66．7％），大细胞NEC 5例（33．3％）；淋巴结转移11 例（73．3％），肝转移者 8 例（53．3％），腹主动脉旁淋巴结转移1 例（6．6％），腹腔盆腔广泛种植转移l例（6．6％）。免疫组化中嗜铬素（CgA）染色阳性9例（60％），突触素（Syn）染色阳性12例（80％），神经元特异性烯醇化酶（NSE）染色阳性10例（66．7％）。 Ki－67增殖指数≥50％者占53．3％（8／15）。随访3～70个月，10例患者死亡，术后1、2、3、5年的生存率分别为62．5％、45．4％、26．6％、13％。结论结直肠神经内分泌癌的临床表现无特异性，容易出现淋巴转移、肝转移和腹膜种植转移。手术切除是最主要的治疗方法，辅助化疗可能使患者获益，但患者总体预后较差。

Analysis of the clinical features and prognosis of 15 cases of colorectal neuroendocrine carcinoma

Objective To investigate the clinical characteristics and prognosis of colorectal neuroendocrine carcinoma (NEC). Methods The clinical data of 15 cases of NEC in our hospital from January 2009 to January 2015 were analyzed retrospectively. The general clinical data , treatment modality, pathological characteristics and prognosis were analyzed. Results The average age of patients was (58.3 ±6.8) years, and the median time of onset was six months. The main clinical symptoms were hematochezia in nine cases (60%), bowel habits change in 10 cases (66.7%), one cases (6.7%) of abdominal mass. Preoperative colonoscopy misdiagnosis rate was 26.7% (4/15). The total radical resection rate was 46.7% (7/15). There were nine cases (60%) of ulcer type and six cases (40%) of protrude type in postoperative gross pathology. Ten cases (66.7%) of small cell NEC and 5 cases (33.3%) of large cell NEC were found by microscope. There were lymph node metastasis in 11 cases (73.3%), liver metastasis in eight cases (53.3%), abdominal aortic lymph node metastasis in one cases (6.6%), abdominal and pelvic cavity extensive implantation metastasis in one patient (6.6%). Chromogranin A (CgA) immunohistochemical staining was positive in nine cases (60%),Synaptophysin (SYN) immunohistochemical staining was positive in 12 patients (80%) and neuron specific enolase (NSE) immunohistochemical staining was positive in 10 cases (66.7%). Ki-67 proliferation index more than 50% accounted for 53.3% (8/15). The patients were followed up for 3~70 months,and 10 patients died. Postoperative 1, 2, 3, 5 year survival rates were 62.5%, 45.4%,26.6%and 13%respectively. Conclusions Colorectal NEC shows no specific clinical manifestation. NEC is prone to develop lymph node metastasis , liver metastasis and peritoneal metastasis. Surgical operation is the primary treatment. Postoperative adjuvant chemotherapy may be beneficial to patients , but the overall prognosis of colorectal NEC is poor.