原发性肝脏神经内分泌癌的治疗研究

Treatment of primary hepatic neuroendocrine tumors

目的 探讨原发性肝脏神经内分泌癌的治疗方法.方法 回顾性分析2003年1月至2010年1月收治的9例原发性肝脏神经内分泌癌患者的治疗方案及预后.结果 9例患者均通过病理确诊,且未发现肝外病灶.9例患者中,单纯化疗1例,单纯放疗1例,单纯射频消融1例.手术6例,均达到R0切除,术后放疗1例,围手术期选择性肝动脉化疗栓塞（transcatheter arterialchemoembolization,TACE）＋术后内放疗1例.2例失访,3例死亡,4例存活至今,其中肝脏肿瘤复发1例,骨转移2例,生存期11d至66个月.结论 原发性肝脏神经内分泌癌是一种罕见的肿瘤,临床早期诊断困难.手术切除是主要的治疗手段,辅以TACE、放疗等综合治疗手段有助于提高患者生存率.

Objective To explore the treatment of primary hepatic neuroendocrine tumors （PHNET）.Methods The therapeutic treatments of 9 PHNET patients from January 2003 to January 2010 in 3 hospitals were retrospective analyzed and followed up.Results Diagnosis of PHNET was confirmed immunohistochemically and by excluding extrahepatic primary sites.The survival is significantly dependent on tumor resectability.One patient received only radiotherapy and one with only chemotherapy,one with radiofrequency ablation.Six patients received R0 resection,one received postoperative radiotherapy,one with TACE perioperatively and internal radiotherapy.Two patients were lost to follow up 3 patients died and 4 were alive.Intrahepatic recurrence was found in 1 patient and metastasis to bone in 2 patients.Survival time ranged from 11 days to 66 months.Conclusions PHNET is an extremely rare entity with difficulty in early diagnosis.Curative liver resection integrated with transarterial chemoembolization or radiotherapy is considered to be an effective modality.