神经内分泌瘤488例临床病理特征及预后分析

Clinicopathological features and prognosis of 488 patients with neuroendocrine tumors

目的探讨神经内分泌瘤(NETs)的临床病理特点,分析其治疗方法及预后。方法回顾性分析郑州大学第一附属医院2012年10月至2017年10月病理确诊为NETs的488例患者的临床病理资料,包括原发部位、发病年龄、性别、转移部位、初诊症状、病理特征、治疗方法及预后。结果共488例患者,男女之比为1∶1.1,年龄(51.0±15.8)岁,病灶位于消化系统370例,肺63例,纵隔14例,其他部位34例,原发灶不明7例,直肠、胃、胰腺是最常见的发病部位。消化系统NETs中G1期190例(51.4%),G2期143例(38.6%),NET-G3期37例(10.0%)。肺NETs中类癌30例(47.6%),不典型类癌33例(52.4%)。临床分期为Ⅰ/Ⅱ期310例(63.5%),Ⅲ期53例(10.9%),Ⅳ期69例(14.1%),无法判断56例(11.5%)。单因素分析显示,NETs患者年龄>50岁、分级、分期、未行手术、肿瘤原发部位、远处转移、淋巴结转移是影响预后的危险因素。多因素Cox回归分析显示,年龄>50岁(HR=2.831,95%CI:1.414~7.029,P=0.025)、远处转移(HR=10.208,95%CI:4.110~25.355,P<0.001)是患者死亡的独立危险因素。结论NETs以直肠、胰腺、胃最为多见,预后较好。年龄和远处转移为影响NETs预后的独立危险因素。

Objective To investigate the clinicopathological features and prognosis of patients with neuroendocrine tumors (NETs). Methods The clinicopathologic data of enrolled patients with NETs between October 2012 and October 2017 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results Among the 488 NETs patients, the average age was (51.0±15.8) years, and the sex ratio (male/female) was 1∶1.1. Of the NETs, 370 were located in the digestive system (75.8%), 63 were pulmonary (12.9%), 14 were mediastinal (2.9%), 7 were of unknown primary origin (1.4%), and 34 were located in other sites (7.0%). Among the NETs, the pancreas, rectum and stomach were the most common sites. In the digestive system NETs, the most common tumor grade was G1 (190 cases, 51.4%), followed by G2 (143 cases, 38.6%) and NET-G3 (37 cases, 10.0%). In pulmonary NETs, typical and atypical carcinoid tumors was 47.6% and 52.4%, respectively. There were 310 patients at stage Ⅰ/Ⅱ, 53 at stage Ⅲ, 69 at stage Ⅳ and 56 at stage undiagnosed, respectively. The relationships among age, stage, grade, metastasis, treatment and prognosis were analyzed. All these factors could influence the survival rate of NET patients. Multivariate Cox analysis showed that age (>50 years old)(HR=2.831, 95%CI:1.414-7.029, P=0.025) and distant metastasis (HR=10.208, 95%CI:4.110-25.355, P<0.001) were independent risk factors. Conclusions The most common primary sites of NETs are the pancreas, rectum, and stomach. Age and distant metastasis are independent risk factors for the prognosis of NETs.