直肠神经内分泌肿瘤的单中心临床研究

Single center clinical study of rectal neuroendocrine neoplasms

目的 :探讨直肠神经内分泌肿瘤(neuroendocrine neoplasms,NENs)患者的临床病理特征、治疗方法、预后及影响因素。方法 :收集郑州大学第一附属医院2011年1月—2016年3月收治的80例直肠NENs患者的临床病理资料和随访资料,对所有标本进行免疫组织化学法检测及分级分期,采用Kaplan-Meier法和COX比例风险模型对可能影响预后的临床病理因素进行单因素和多因素分析。结果:80例患者中,男性47例,女性33例;中位年龄52岁(范围:20~75岁),肿瘤平均直径为1.65 cm,常见症状为排便习惯改变(37.5%)、便血(23.7%)和腹痛(16.3%)。嗜铬粒蛋白A(chromogranin,Cg A)的阳性率为50.0%,突触素(synaptophysin,Syn)的阳性率为97.5%。74例行手术治疗,12例接受化疗。随访时间3~57个月,中位无进展生存时间为20个月(95%可信区间为15.354~24.646个月)。全组患者1年和3年的总生存率为93.4%和85.7%。多因素分析结果显示,美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)体能状况评分(P<0.001)、肿瘤直径(P=0.010)、Ki-67阳性指数(P=0.020)、TNM分期(P=0.012)是与预后相关独立危险因素。结论 :直肠NENs较罕见,但发病率呈明显上升趋势。手术切除是首选治疗手段。ECOG体能状况评分、肿瘤直径、Ki-67阳性指数、TNM分期是与预后相关独立危险因素。

Objective： To investigate the clinicopathological features, diagnosis, treatment, prognosis and the related factors of patients with rectal neuroendocrine neoplasms （NENs）. Methods： The clinicopathological characteristics and follow-up data of 80 patients with rectal NENs who were treated in the First Affiliated Hospital of Zhengzhou University from January 2011 to March 2016 were collected. All specimens were immunohistochemically stained and staged. The Kaplan-Meier method and COX proportional hazard model were used for univariate and multivariate analyses of prognosis-related factors. Results： Among the 80 patients, there were 47 males and 33 females; the median age was 52 years old （range：20-75 years）. The mean diameter of tumors was 1.65 cm. The common symptoms were changes of bowel habits （37.5%）, hematochezia （23.7%） and abdominal pain （16.3%）. The positive rates of chromogranin A （CgA） and synaptophysin （Syn） were 50.0% and 97.5%, respectively. Seventy-four cases underwent surgical treatment, and 12 cases received chemotherapy. The follow-up time ranged from 3 to 57 months. The median progression-free survival time was 20 months （95% confidence interval：15.354-24.646 months）. The 1-and 3-year overall survival rates were 93.4% and 85.7%, respectively. Multivariate analysis showed that the Eastern Cooperative Oncology Group （ECOG） performance status （PS） score （P〈0.001）, tumor diameter （P=0.010）, Ki-67 index （P=0.020） and TNM stage （P=0.012） were independent risk factors associated with prognosis. Conclusion： Rectal NENs is rare, but the morbidity is significantly increased. Surgical resection is the preferred treatment. The independent prognostic factors are ECOG PS score, tumor diameter, Ki-67 index and TNM stage.