消化道神经内分泌肿瘤不同手术方式疗效比较及预后分析

Different surgical methods for gastrointestinal neuroendocrine tumors: comparison on efficacy and prognosis

目的探讨影响消化道神经内分泌肿瘤患者术后复发转移的相关危险因素,并比较不同手术方式的疗效及对预后的影响。方法回顾性分析2010年1月~2019年12月收治的153例消化道神经内分泌肿瘤患者资料,分析患者临床特征,计算其5年复发转移率,同时进行预后因素分析及生存分析,并对不同手术方式的疗效进行比较。结果 153例患者中,男性90例(58.82%),女性63例(41.18%);G1期114例(74.51%),G2期25例(16.34%),G3期14例(9.15%),接受内镜手术112例(73.20%),外科手术41例(26.80%),5年内复发转移人数26人(16.99%)。手术部位在十二指肠、食管、胃和直肠的5年复发转移率分别为1.31%、3.92%、3.27%和8.50%。采用内镜手术和外科手术的患者5年内复发转移率分别为3.92%和13.07%。Log-rank检验结果显示,不同年龄、不同肿瘤部位、不同肿瘤直径、不同病理分级以及不同手术方式的肿瘤复发转移时间存在统计学差异(P<0.05)。多因素Cox回归分析显示肿瘤直径、病理分级和切缘见肿瘤组织是影响术后患者复发转移的独立危险因素(P<0.05),且肿瘤直径越大、病理分级越高,术后患者复发转移风险越高。G1、G2期直径不超过2 cm的消化道神经内分泌肿瘤的不同手术的复发转移率无统计学差异(P>0.05)。结论肿瘤直径、病理分级和切缘见肿瘤组织是影响术后患者复发转移的独立危险因素,G1、G2期直径不超过2 cm的消化道神经内分泌肿瘤可在内镜下切除。

Objective To investigate the related risk factors affecting postoperative recurrence and recurrent metastasis in the patients with gastrointestinal neuroendocrine tumors(GI-NETs), and compare the therapeutic efficacy of different surgical methods as well as their impacts on prognosis. Methods The clinical data of 153 GI-NETs patients treated in our hospital from January 2010 to December 2019 were collected and retrospectively analyzed. The clinical characteristics and 5-year recurrence and metastasis rates were analyzed and calculated, and the prognostic factors and survival analysis was subsequently performed. In addition, the therapeutic efficacy was evaluated and compared between the endoscopic surgery and conventional surgery. Results Among the 153 GI-NETs patients, 90 were males(58.82%) and 63 females(41.18%). According to the 2010 WHO NETs classification, 114 cases(74.51%) were in G1 phases, 25(16.34%) in G2 phases and 14(9.15%) in G3 phases. And 112 patients(73.20%) underwent endoscopic surgery and 41(26.80%) received conventional surgery. There were 26 cases(16.99%) experiencing recurrence and metastasis within 5 years, with the percentages of 1.31%, 3.92%, 3.27% and 8.50%, respectively in the duodenum, esophagus, stomach and rectum. The rates of recurrence and metastasis were 3.92% and 13.07% respectively in the endoscopic surgery and conventional surgery. Log-rank test results indicated that there were statistical differences in the recurrence and metastasis of GI-NETs among different ages, tumor sites, tumor sizes, pathological grades, and surgical methods(P<0.05). Multivariate Cox regression analysis showed that tumor size, pathological grade, and presence of tumor in the margin were independent risk factors affecting postoperative recurrence and metastasis(P<0.05), and the larger the tumor size and the higher the pathological grade, the higher the risks were. No statistical differences were seen in the recurrence and metastasis rates in the patients with G1 or G2 phase GI-NETs less than 2 cm, regardless of the surgery methods they received(P>0.05). Conclusion Tumor size, pathological grade and presence of tumor in the margin are independent risk factors for postoperative recurrence and metastasis. GI-NETs in G1 and G2 phases less than 2 cm can be resected under endoscopy.