原发性胃神经内分泌肿瘤的临床特点、病理及预后分析

Clinical features and prognostic factors of primary gastric neuroendocrine neoplasms

目的:比较胃神经内分泌肿瘤(NEN)各临床分型的临床病理特征,并分析其中胃神经内分泌癌(NEC)及混合性腺-神经内分泌癌(MANEC)的预后影响因素。方法:将苏州大学附属第一医院和南京医科大学第一附属医院148例胃NEN按欧洲神经内分泌肿瘤协会(ENETS)临床分型标准分为Ⅰ型、Ⅱ型、Ⅲ型,比较各型胃NEN的临床、胃镜及病理特征,分别采用Kaplan-Meier检验、Cox回归模型对其中108例病理分级为G3级的胃NEN患者进行单因素和多因素生存分析。结果:纳入的Ⅰ型、Ⅱ型、Ⅲ型NEN患者分别为37例(25.0%)、5例(3.4%)和106例(71.6%)。Ⅰ型有28例(75.7%)为胃底/胃体病变,29例(78.4%)为隆起灶,4例(10.8%)有淋巴结受累,余均为局限性病变,26例(70.3%)内镜治疗,11例(29.7%)接受外科手术。5例Ⅱ型胃NEN的瘤体均位于胃底/胃体,4例为溃疡灶,均予内镜治疗;患者中合并胃泌素瘤3例,另2例合并多发性内分泌肿瘤Ⅰ型。Ⅲ型中56例(52.8%)为贲门病变,81例(76.4%)表现为溃疡,单发病灶为102例(96.2%),淋巴结受累或器官转移共94例(88.7%)。本研究中病理分级G1/G2级的40例胃NEN随访期间无死亡病例发生;108例G3级NEN患者中死亡42例。生存分析显示,患者年龄≥60岁、肿瘤有淋巴结或器官转移与G3级NEN患者不良预后有关联(P=0.041,0.025)。结论:不同临床分型胃NEN的性别分布、年龄、胃镜特征、浸润转移情况、病理分级差异较大,高龄和肿瘤发生转移浸润是G3级胃NEN不良预后的危险因素。

Objective To study the clinical characteristics and classification of gastric neuroendocrine neoplasm(NEN)and prognostic factors of mixed adenoneuroendocrine carcinoma(MANEC)and gastric neuroendocrine carcinoma(NEC).Methods A total of 148 gastric NENs were divided into typeⅠ,typeⅡand typeⅢbased on the classification of European Neuroendocrine Tumor Society(ENETS).Kaplan-Meier test and Cox regression model were used in univariate and multivariate survival analysis in 108 cases with pathological G3 gastric NEN.Results In this study,the percentages of typeⅠ,typeⅡand typeⅢwere 25.0%(37),3.4%(5)and 71.6%(106)respectively.Among typeⅠpatients,28(75.7%)lesions were located in gastric fundus or body,29(78.4%)had bumps.Lymph node involvement was found in 4(10.8%)patients.Twenty-six(70.3%)patients received endoscopic treatment and 11(29.7%)with surgery.All 5 typeⅡpatients presented lesions in gastric fundus or body,including 4 with ulcers,who were all treated by endoscope.Three typeⅡpatients had gastrinoma,and 2 combined with multiple endocrine neoplasmⅠ.In typeⅢpatients,56(52.8%)showed ulcerative lesions.The majority of patients(102,96.2%)had a single lesion,94(88.7%)with lymph node or other organ metastasis.In this study,no deaths were reported in gastric NEN with a pathological grade of G1 or G2.The mortality rate was 38.9%(42/108)in patients with G3 NEN.Survival analysis suggested that age,metastasis of tumor were associated with poor prognosis(P=0.041,0.025).Conclusions Patients with gastric NEN have heterogenous clinical presentations according to gender,age,endoscopic features,infiltration and metastasis,and pathological grade.Aging and metastasis are negative prognostic factors of G3 gastric NEN.