2001—2010年中国胃肠胰神经内分泌癌临床流行病学研究

Clinical Epidemiological Study of Gastroenteropancreatic Neuroendocrine Carcinoma in China,2001—2010

[目的]探讨中国胃肠胰神经内分泌癌(gastroenteropancreatic neuroendocrine carcinoma,GEP-NEC)的临床流行病学特征。[方法]本研究是一项基于医院的全国多中心10年(2001—2010年)回顾性临床流行病学调查研究。根据2010年WHO消化道肿瘤分类标准重新归类病案资料,纳入病理诊断为GEP-NEC和胃肠胰神经内分泌瘤(gastroenteropancreatic neuroendocrine tumor,GEP-NET)的患者,采用病例报告表,收集患者人口统计学信息、潜在危险因素、临床诊疗特点,研究GEP-NEC与GEP-NET临床表现、影像学检查、临床病理结果、治疗方式等的差异。[结果]共479例确诊为GEP-NEC,其高发部位为胃(66.6%,319/479)、直肠(11.3%,54/479)、胰腺(8.4%,40/479)。相较GEP-NET,GEP-NEC在老年、男性、有吸烟史人群中更常见(P<0.001)。GEP-NEC病例数呈现持续增加趋势,与GEP-NET相比,具有脉管内瘤栓、神经侵犯、坏死等恶性特征的患者比例更大(P<0.05),诊断时发生局部浸润或远处转移的患者比例更大(P<0.001),仅24.2%患者局限于原发部位。88.1%(422/479)的GEP-NEC患者接受了开放式手术,接受化疗的患者构成比高于GEP-NET(P<0.001)。[结论]中国GEP-NEC病例数呈现持续增加趋势,诊断时多处于局部浸润或远处转移。对这一类少见且高度异质性的肿瘤,需要更多临床流行病学研究,为临床早诊早治提供依据。

[Purpose]To investigate clinical epidemiological feature of gastroenteropancreatic neuroendocrine carcinoma(GEP-NEC)in China.[Methods]This was a hospital-based,nation-wide,and multi-center 10-year(2001—2010)retrospective study.The medical records were reclassified according to the 2010 WHO classification of gastrointestinal tumors,and patients pathologically diagnosed as GEP-NEC and patients with gastroenteropancreatic neuroendocrine tumors(GEP-NET)were included in the analysis.The data of demographic information,potential risk factors,features of clinical diagnosis and treatment were collected;and the differences in clinical characteristics,imaging findings,pathological results and treatment methods were compared between patients with GEP-NEC and GEP-NET.[Results]There were 479 cases of GEP-NEC,and the stomach was most involved organ(66.6%,319/479),followed by rectum(11.3%,54/479)and pancreas(8.4%,40/479).Compared with GEP-NET,GEP-NEC was more prevalent in the elderly,male,and those with a history of smoking(P<0.001).The case number of GEP-NEC showed continued increase.Compared with GEP-NET patients,there was a higher proportion of GEP-NEC patients with malignant features such as intravascular thrombosis,nerve infiltration,necrosis(P<0.05),and a greater proportion of GEP-NEC with local infiltration or distant metastasis at diagnosis(P<0.001),only 24.2%of GEP-NEC were confined to the primary site.88.1%of GEP-NEC received open surgery,and the proportion of patients receiving chemotherapy was higher than that of NET(P<0.001).[Conclusion]The number of GEP-NEC cases in China has been increasing and the majority were local invasion or metastatic at diagnosis.For rare and highly heterogeneous tumors like GEP-NEC,more clinical epidemiological studies are needed to provide evidence for early diagnosis and treatment.