具有神经内分泌特征胃癌的诊治及预后分析

目的探讨具有神经内分泌特征胃癌的临床病理特点、治疗及预后。方法回顾性分析北京大学临床肿瘤学院1997年1月至2008年12月收治的19例具有神经内分泌特征胃癌病例的临床资料。结果本组19例患者中胃神经内分泌癌14例，其中9例位于胃底贲门，5例位于胃体；另5例胃癌伴神经内分泌分化者中2例位于胃底贲门，2例位于胃窦，1例位于全胃。根据2000年WHO肿瘤国际组织新分类标准．本组19例患者可分为Ⅰ型胃类癌2例（10．5％），Ⅱ型散发性胃类癌9例（47．4％），胃小细胞癌3例（15．8％），胃癌伴神经内分泌分化5例（26．3％）。临床无特异性表现，诊断主要依靠病理及免疫组织化学检查。18例患者接受手术治疗，手术采用根治性胃大部切除术或全胃切除术．3例伴肝转移者行同时性肝转移灶切除：另1例胃体小细胞癌伴肝转移无耘．手术切除者予以单纯化疗。本组患者1年及3年生存率分别为73．7％和38．6％。结论胃神经内分泌癌好发于贲门、胃底部及胃体，胃癌伴神经内分泌分化可发生于胃的各个部位。免疫组织化学染色对该病的诊断具有重要价值。本病总体预后不佳．治疗应尽可能行根治性切除术。

Gastric neuroendocrine carcinoma and gastric carcinoma with neuroendocrine cell differentiation:a clinical and prognostic analysis

Objective To investigate the clinicopathological features, treatment, and prognosis of gastric neuroendocrine carcinoma and gastric carcinoma with neuroendocrine cell differentiation.Methods A total of 19 patients were treated for gastric neuroendocrine cancer or gastric cancer with neuroendocrine differentiation in the Beijing Cancer Hospital from January 1997 to December 2008.Clinical data were retrospectively analyzed. Results Fourteen patients had neuroendocrine carcinoma in the gastric cardia (n=9) or gastric body(n=5), and 5 patients had gastric cancer with neuroendocrine differentiation in the gastric cardia(n=2), the antrum(n=2), and the entire stomach(n=1). According to the International Classification of Disease for Oncology (2000), patients were divided into gastric carcinoid type Ⅰ (n=2, 10.5%), type Ⅲ sporadic gastric carcinoid (n=9, 47.4%), small cell carcinoma of the stomach (n=3, 15.8%), and gastric cancer with neuroendocrine cell differentiation (n=5,26.3% ). Clinical manifestations were mostly non-specific. Diagnosis was based on pathological and immunohistochemical examination. Eighteen patients underwent surgery including radical subtotal gastrectomy and total gastrectomy, of whom 3 underwent simultaneous resection of the liver metastasis.The remaining one patient with small cell carcinoma of the gastric body received chemotherapy alone because of unresectable liver metastasis. The survival rate was 73.7% at 1 year and 38.6% at 3 years. Conclusions Gastric neuroendocrine carcinoma usually develops in the cardia and body of the stomach. Gastric carcinoma with neuroendocrine cell differentiation can occur in any locations of the stomach. Immunohistochemistry is important to the diagnosis. Radical resection is the main treatment.