胃神经内分泌肿瘤的病理学特征及临床意义

Pathological Features and Clinical Significance of Gastric Neuroendocrine Neoplasms

目的探讨142例胃神经内分泌肿瘤(G-NENs)的病理学特征及临床意义。方法收集142例2017年1月至2019年12月郑州大学第一附属医院收治的G-NENs患者的临床资料,分析G-NENs不同分级分型的临床病理特征。结果142例G-NENs中,Ⅰ型43例(30.28%)、Ⅱ型10例(7.04%)、Ⅲ型32例(22.54%)、NEC[神经内分泌癌,包括混合性腺神经内分泌癌(MANEC)]57例(40.14%)。不同分型G-NENs在性别、发病年龄、肿瘤部位、肿瘤数目、肿瘤形态及最大径、病理分级、有无转移方面差异有统计学意义(P<0.05)。突触素(Syn)阳性率100%,嗜铬素A(CgA)阳性率67.60%,神经内分泌瘤(NET)中CgA阳性率高于NEC。Ⅰ型及Ⅱ型多接受内镜下切除治疗(67.44%,80.00%),其余Ⅰ型分别接受动态观察、内镜切除+奥曲肽/化疗、手术切除(16.28%、11.63%、4.65%),Ⅱ型接受手术切除(20.00%)。Ⅲ型分别接受内镜下治疗、手术切除、化疗(59.38%、34.37%、6.25%)。G-NEC/MANEC接受手术联合化疗(56.14%)/化疗(35.09%),其余接受单纯手术(8.77%)。随访期间22例死亡,其中2例为Ⅲ型NET G3,20例为G-NEC/MANEC,患者均发生淋巴结/肝转移。结论Ⅰ型、Ⅱ型G-NET镜下肿瘤形态无区别,多为G1、G2,内镜下应多点取材,了解背景胃黏膜的改变,进一步从病理角度协助G-NET的分型诊断。Ⅲ型G-NET预后比Ⅰ型、Ⅱ型差,且随着分级的增高,转移率也随之增加。G-NEC/MANEC为分化差的癌,生物学行为及治疗原则同普通型胃癌。

Objective To investigate the pathological features and clinical significance of gastric neuroendocrine neoplasms(G-NENs).Methods A total of 142 cases with G-NENs diagnosed in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2019 were collected,and the clinicopathological features of different grades and types were analyzed.Results Among the 142 cases of G-NENs,the cases of typeⅠ,typeⅡ,typeⅢand NEC(including MANEC)were 43(30.28%),10(7.04%),32(22.54%)and 57(40.14%)respectively.Different types of G-NENS showed statistically significant differences in gender,age of onset,tumor site,number of tumors,tumor morphology and maximum diameter,pathological grade,and metastasis.The positive rate of Syn was 100%and that of CgA was 67.60%.The positive rate of CgA in NET was higher than that of NEC.Most of the typeⅠand typeⅡcases were treated with endoscopic resection(67.44%,80.00%),the other typeⅠcases were treated with dynamic observation,endoscopic resection+octreotide/chemotherapy and surgical resection(16.28%,11.63%,4.65%),and 2 of the typeⅡcases were surgically resected(20.00%).Most of the typeⅢcases(59.38%)underwent endoscopic treatment,and 11 cases(34.37%)underwent surgical resection,and 2 cases(6.25%)received chemotherapy.G-NEC/MANEC was mainly treated with surgery combined with chemotherapy(56.14%)/chemotherapy(35.09%),the other 5 cases(8.77%)underwent simple operation.During the follow-up period,22 cases died,including 2 cases of typeⅢNET G3 and 20 cases of G-NEC/MANEC,both of which had lymph node/liver metastasis.Conclusion There is no difference in tumor morphology between typeⅠand typeⅡG-NET,and most of them are G1 and G2.Multiple samples should be taken under endoscope to understand the changes of background gastric mucosa and further assist the classification and diagnosis of G-NET from the perspective of pathology,which can prompt clinicians to do relevant examination.The prognosis of typeⅢG-NET is worse than that of typeⅠand typeⅡ,and the metastasis rate increases with the increase of grade.Clinical attention should be paid to the treatment of NET G3.G-NEC/MANEC is a poorly differentiated cancer,and its biological behavior and treatment principles are the same as those of common gastric cancer.