胃神经内分泌癌的临床诊治和预后分析

Clinical and prognostic analysis of 52 patients with gastric neuroendocrine carcinoma

目的探讨胃神经内分泌癌（gastricneuroendocrinecarcinoma，G—NEC）的临床表现、诊断、治疗及预后。方法对苏州大学附属第一医院2006年8月至2014年12月收治的52例G—NEC患者的临床病理资料进行回顾性分析。采用Kaplan-Meier法绘制生存曲线．Log—rank检验进行单因素分析，COX比例风险回归模型进行多因素分析。结果随访52例G．NEC患者生存时间为6～61个月，中位生存时间为19个月，1、3、5年生存率为74％、16％、5％。单因素分析显示肿瘤分期、手术性质、脉管神经是否受累、Ⅲ期和Ⅳ期是否化疗均与患者的预后有关（X^2=24．254、10．005、7．261、8．790，均P〈0．05）；多因素分析显示肿瘤分期和脉管神经是否受累是影响患者预后的独立危险因素（X^2=17．170、5．810，均P〈0．05）。结论G-NEC恶性程度高，预后差，术前诊断率较低，术前取活检并行免疫组化检查可提高术前诊断率。手术是首选治疗方案，确诊依赖于术后病理学及免疫组化检查。

Objective To investigate the clinical features, diagnosis, treatment and prognosis of gastric neuroendocrine carcinoma （G-NEC）. Methods Clinical data of 52 G-NEC cases were analyzed. Follow-up was conducted by telephone. The survival curves were drawn using Kaplan-Meier method. Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by COX proportional hazards model. Results The median overall survival rate was 19 months （range 6 to 61 months） ,and the overall 1,3,5-year survival rates were 74% , 16% and 5% respectively. Tumor stage surgery, vascular nerve involvement and Ⅲ and Ⅳ phase chemotherapy were related to prognosis （X2 = 24. 254, 10. 005,7. 261, 8. 790, all P 〈 0. 05 ）. Multivariate analysis showed tumor stage and vascular nerve involvement were independent prognostic factors （X2 = 17. 170, 5. 810, all P 〈 0.05 ） . Conclusion G-NEC is a highly malignant tumor with poor prognosis. Preoperative diagnosis rate is low. Surgery is the treatment of first choice. Definite diagnosis depends on postoperative pathology and immunohistochemical examination.