胃肠胰神经内分泌肿瘤临床诊治42例分析

Clinicopathologic analysis and recognition of gastroenteropancreatic neuroendocrine tumors:an analysis of 42 cases

目的研究胃肠胰神经内分泌肿瘤(GEP-NET)临床治疗预后及病理特征,探讨对胃肠胰神经内分泌肿瘤的再认识及临床合理抉择。方法根据2010年WHO病理新分类,回顾性总结42例经内镜检查或病理诊断为胃肠胰神经内分泌肿瘤,并通过内镜或外科治疗的患者临床资料,进行随访观察,分析其临床表现、临床治疗方式、组织病理学特点、预后因素等。结果 42例胃肠胰神经内分泌肿瘤中,13进行了内镜切除手术,其中4例补行外科手术,直接行外科手术27例,2例起源不明的腹膜后神经内分泌肿瘤放弃手术。按2010年WHO病理分类:神经内分泌肿瘤(NET)30例,其中16例为直肠NET,1例为结肠NET,4例为阑尾NET,6例为胃部NET,2例为十二指肠NET,1例为胰腺NET;神经内分泌癌(NEC)9例,其中大细胞癌4例、小细胞癌5例;混合腺/神经内分泌癌(MANEC)1例;胰岛细胞瘤2例。增殖活性分级,低级别(G1)30例,中级别(G2)2例,高级别(G3)10例。术后随访:低级别类癌预后良好,内镜治疗后复发1例;高级别神经内分泌癌预后差,复发转移率高。结论对胃肠胰神经内分泌肿瘤(NET1-2级)应以外科治疗为主,可选择性内镜治疗,但术前需内镜超声或CT影像充分评估。神经内分泌癌复发转移率高,预后差,需加强多学科综合治疗。

Objective To evaluate the therapeutic effects of surgical treatment and clinicopathologic features in gastro- enteropancreatic neuroendocrine tumors（GEN-NET） , and discuss the strategies of treatment. Methods According to WHO 2010 classfication of gastroenteropancreatic neuroendocrine tumors, 42 cases of GEN-NETs had been treated and followed up in the people＇s hospital of Guanxi Zhuang autonomous region between March 2005 and March 2011. A retrospective review for clinical findings, surgical methods, histopathologieal features, and prognosis was used to determine the appropriate way of treament for gastroenteropanereatic neuroendocrine tumors. Results Among the 42 patients, 13 cases were treated by Endoscopic mucosal re- section , but 4 cases underwent salvage surgery, and 27 cases underwent radical resection,2 cases of unknown original retroperito- neal NET given up operation. Classication of GEN-NET was as follows： 30 cases of neuroendocrine tumor,9 cases of neuroendo- crine carcinoma, 1 cases of Mixed gland/neuroendocrine carcinoma,2cases of Insulinoma. According to differentiation, low grade （ GI ） NETs included 30 cases, intermediate-grade NETs （ G2 ） 2 cases, and 10 cases of high grade （ G3 ）. Poorly differentiated （high-grade） NETs had higher rate of recurrence and metastasis with poor outcome than low grade （ G1 ） NETs. Conclusion Sur- gery was still the main reasonable treatment for gastroenteropancreatic neuroendocrine tumors, especially NET1-2, a part of cases could select Endoscopic resection,but sufficient preoperative assessment was necessary. Multidiciplinary treatment （MDT） should be performed in these cases of neuroendocrine carcinoma,because of high recurrence rate and poor prognosis.