胃肠胰神经内分泌肿瘤的临床病理特点及其与预后的关系

Gastroenteropancreatic neuroendocrine neoplasms: Clinicopathologic characteristics and their correlation with prognosis

目的:分析胃肠胰神经内分泌肿瘤(gastroenteropancreafic neuroendocrine neoplasm,GEPNEN)的临床病理特点及其与预后的关系.方法:收集哈尔滨医科大学附属肿瘤医院2007-04/2013-04通过病理诊断为GEP-NEN的患者资料,Kaplan-Meier法进行生存分析,Logrank法比较临床病理特点与预后的关系,多因素Cox回归分析影响患者预后的独立危险因素结果:43例患者的平均年龄为57.5岁,男女性别比为2.91∶1.原发部位中以胃部最多(19例,44.19%).2例为功能性的GEP-NEN(1例为胰高血糖素瘤,1例出现类癌综合征).有14例术后经过药物治疗.43例患者中死亡22例(52.38%),失访1例(2.38%).患者1、3年生存率分别为70.2%、36.9%,中位总生存期为16.0mo.单因素分析显示:肿瘤大小(≥5 cm)、T分期、淋巴结转移、远处转移以及病理类型为神经内分泌癌(neuroendocrine carcinoma N E C)、混合性腺神经内分泌癌(m i x e d adenoneuroen docrine carcinoma,MANEC)影响患者的预后(P<0.05).患者年龄、性别、吸烟史、饮酒史、肿瘤家族史、手术方式及术后药物治疗与预后无相关性.多因素分析显示:淋巴结转移、远处转移及病理类型是预后的独立危险因素.结论:胃是GEP-NEN最常见的原发部位,临床表现无特异性.淋巴结转移、远处转移及病理类型是预后的独立危险因素.

AIM： To analyze the clinicopathologic character- istics of gastroenteropancreatic neuroendocrine neoplasms （GEP-NEN） and their correlation with prognosis. METHODS： Clinical data for 43 patients diag- nosed pathologically with GEP-NEN in Har- bin Medical University Cancer Hospital from April 2007 to April 2013 were retrospectively analyzed. Survival analysis was performed by Kaplan-Meier method. The relationship between clinicopathologic characteristics and prognosis was analyzed using the Log-rank test. Indepen- dent risk factors for prognosis were analyzed by multivariate Cox regression analysis.RESULTS： The mean age was 57.5 years, with a male-to-female ratio of 2.91：1. The most com- mon site was stomach （19 cases, 44.19%）. There were 2 cases of functional GEP-NEN （one case of glucagonoma and another case of carcinoid syn- drome）. Of the 43 patients, 14 received postop- erative drug therapy. There were 22 deaths in 43 patients （52.38%） and one case （2.38%） was lost to follow-up. The 1- and 3-year survival rates were 70.2% and 36.9%, with a median overall survival （OS） of 16.0 months. Univariate analysis showed that tumor size （≥5 cm）, depth of inva- sion, lymph node metastasis, distant metastasis and pathological grades of NEC （neuroendocrine carcinoma） and MANEC （mixed adenoneuroen docrine carcinoma） could affect the patient＇s prognosis （P 〈 0.05 for all）. Age, gender, smok- ing, drinking, family history of cancer, surgical approach and postoperative drug therapy were not significantly associated with prognosis. Mul- tivariate analysis showed that lymph node me- tastasis, distant metastasis and pathological type were independent risk factors. CONCLUSION： The stomach is the most com- mon primary site of GEP-NEN, and GEP-NEN lacks specific clinical manifestations. Lymph node metastasis, distant metastasis and patho- logical type are independent risk factors.