胃神经内分泌肿瘤的临床病理特征及根治性手术后预后分析

A study of clinical characteristics and prognostic factors of 49 patients with gastric neuroendocrine neoplasm treated with radical surgery

目的探讨胃神经内分泌肿瘤(g-NENs)的临床病理特征及影响根治性手术后预后因素。方法回顾性分析2002年1月至2011年12月复旦大学附属中山医院普通外科行根治性手术治疗的49例胃神经内分泌肿瘤病人的临床病理资料。依照2010年WHO消化系统肿瘤分类标准,对肿瘤进行命名、分级和分期。通过电话、信件及门诊复诊方式进行随访。采用Kaplan-Meier法绘制生存曲线和计算存活率,Log-rank检验法行单因素分析,Cox比例风险回归模型进行多因素分析。结果 49例病人中,胃神经内分泌瘤6例(G1级和G2级各3例)、胃神经内分泌癌(G3级)43例。肿瘤大小为1.5 cm×2.5 cm×0.5 cm^7.0 cm×8.0 cm×1.5 cm。局限性肿瘤15例、伴淋巴结转移33例、肝转移1例。截至末次随访日,随访率98.0%(48/49),中位随访时间22.2个月。病人中位生存时间43.0(0.2~91.7)个月。病人1、3、5年存活率分别为85.7%、50.7%、41.6%。单因素分析结果显示:病人性别和淋巴结侵犯是影响g-NENs病人预后的因素(χ2=6.359,4.036,P<0.05)。多因素分析结果显示:性别是影响g-NENs病人预后的独立因素(P<0.05)。结论 g-NENs病人的临床表现无特异性,多数病人就诊时已伴有淋巴结或远处转移。女性g-NENs病人术后较男性具有生存优势。

Objective To study and explore the clinical characteristics and prognostic factors of patients with gastric neuroendocrine neoplasms （g-NENs） treated with radical surgeries. Methods The clinical and pathological data of 49 g-NENs patients who underwent surgery from January 2002 to December 2011 at the Zhongshan Hospital of Fudan University were analyzed retrospectively. The neoplasms were nominated and classified into different grades and stages according to the latest WHO classification of g-NENs. Follow-up was conducted by telephone, mail or returning visit survey. The overall survival rates were calculated and the survival curves were drawn using the Kaplan-Meier method. Univariate analysis was performed by the Log-rank test, and multivariate analysis was performed by the COX proportional hazards model. Results Among the 49 g-NENs patients, 37 were male and 12 were female, with an average age of 66 years. 6 neuroendocrine tumors （including G1 and G2） and 43 neuroendocrine carcinomas （G3）. The tumor sizes ranged from 1.5cm × 2.5cm ×0.5cm-7cm ×8cm ×1.5cm. 15 NENs were localized, 33 had lymph node involvement and 1 had hepatic metastasis. At the end of the follow-up, the follow-up rate was 98.0% （48/49）, and the median follow-up time was 22.2 months. The median overall survival rate of g-NENs patients was 43 months, and the overall 1-, 2-, and 5-year survival rates were 85.7%, 50.7%, 41.6% respectively. Sex （χ2=6.359, P〈0.05） and lymph node involvement （χ2=4.036, P〈0.05） were prognostic factors of postoperative g-NENs patients, among which sex was an independent prognostic factor （P〈0.05）. Conclusions Most of the patients with g-NENs had nonspecific symptoms.When diagnosed, lymph node or distant metastases were present in most patients. Female patients had a survival advantage.