分化差的胃神经内分泌肿瘤预后分析

Prognosis of Poorly-differentiated Gastric Neuroendocrine Neoplasm

目的探讨分化差的胃神经内分泌肿瘤的临床病理特点和辅助治疗对预后的影响。方法回顾性分析经根治性手术治疗的胃神经内分泌肿瘤124例,根据肿瘤分类标准对肿瘤进行分类、分级和分期,并进行随访,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。结果胃神经内分泌瘤、胃神经内分泌癌和混合性腺神经内分泌癌的5年生存率分别为100%、52.4%和38.8%,多因素分析示淋巴结转移与否(P=0.030)和有无辅助治疗(P=0.017),尤其是顺铂联合依托泊苷方案(HR=0.051, P=0.015)是影响胃神经内分泌癌患者的独立预后因素;而淋巴结转移、远处转移、TNM分期和有无辅助治疗均不是混合性腺神经内分泌癌患者的独立预后因素。结论胃神经内分泌癌患者的预后与淋巴结转移和有无辅助治疗有关,其辅助治疗可以考虑顺铂联合依托泊苷方案。

Objective To explore the effects of clinicopathological features and adjuvant therapy on the prognosis of patients with poorly-differentiated gastric neuroendocrine tumors. Methods We retrospectively analyzed 124 cases of gastric neuroendocrine tumors treated with radical surgery. The neoplasms were classified into different types, grades and stages according to the standard of classification. Follow-up was conducted. The survival curves were drawn by Kaplan-Meier method. Univariate analysis was performed by Log rank test and multivariate analysis was conducted by Cox proportional hazards model. Results The5-year survival rates of gastric neuroendocrine tumor, gastric neuroendocrine carcinoma and gastric mixed adenoneuroendocrine carcinoma patients were 100%, 52.4% and 38.8%, respectively. Multivariate analysis showed that lymph node metastasis(P=0.030) and adjuvant therapy(P=0.017), especially cisplatin combined with etoposide regimen(HR=0.051, P=0.015) were independent prognostic factors for patients with gastric neuroendocrine carcinoma;while lymph node metastasis, distant metastasis, TNM stage and adjuvant therapy were not independent prognostic factors for patients with mixed neuroendocrine carcinoma. Conclusion The prognosis of patients with gastric neuroendocrine carcinoma is related to lymph node metastasis and adjuvant treatment, and cisplatin plus etoposide regimen is a reasonable choice for adjuvant treatment.