背景与目的:胃神经内分泌肿瘤(neuroendocrine neoplasm,NEN)是胃恶性肿瘤中一种较为罕见的类别,根据2019年世界卫生组织(World Health Organization,WHO)消化系统NEN的分类标准,分为分化好的神经内分泌瘤(neuroendocrine tumor,NET)和...背景与目的:胃神经内分泌肿瘤(neuroendocrine neoplasm,NEN)是胃恶性肿瘤中一种较为罕见的类别,根据2019年世界卫生组织(World Health Organization,WHO)消化系统NEN的分类标准,分为分化好的神经内分泌瘤(neuroendocrine tumor,NET)和分化差的神经内分泌癌(neuroendocrine carcinoma,NEC)。目前,关于胃NEC(gastric NEC,GNEC)辅助化疗预后的研究匮乏,本研究旨在探讨辅助化疗能否使GNEC患者获益,以期为临床决策提供参考依据。方法:回顾性分析中山大学肿瘤防治中心、中山大学附属第一医院和复旦大学附属肿瘤医院2008年7月—2019年6月收治的184例GNEC患者的临床病理学资料,随访截至2022年5月31日。利用Kaplan-Meier法绘制生存曲线,根据单因素COX回归分析和多因素COX回归分析筛选出影响GNEC患者生存的独立预后因素,并进一步分析化疗、手术等因素对患者预后的影响。检验水准为α=0.05,所有统计学分析均使用SPSS 25.0软件。结果:单因素分析显示,手术(P<0.001)、化疗(P<0.001)、综合治疗模式(P<0.001)、N分期(P=0.029)、M分期(P<0.001)及TNM综合分期(P<0.001)是影响GNEC患者预后的变量。多因素COX回归分析显示,手术(P<0.001)、化疗(P<0.001)及M分期(P<0.001)是影响GNEC患者生存的独立预后因素。在所有患者中,TNMⅠ、Ⅱ、Ⅲ和Ⅳ期的3年累积生存率分别为51.9%、55.8%、40.7%和23.6%。在行根治性切除的患者中,辅助化疗可以改善GNEC患者的预后,辅助化疗和非辅助化疗的3年累积生存率分别为58.8%和33.3%(P=0.008)。分层分析结果显示,辅助化疗能够改善TNMⅡ(P=0.018)和Ⅲ期(P=0.023)患者的预后。此外,NEC化疗方案[依托泊苷+顺铂(etoposide plus cisplatin,EP)、伊立替康+顺铂(irinotecan plus cisplatin,IP)]与胃腺癌方案[奥沙利铂+卡培他滨(oxaliplatin plus capecitabine,XELOX)、奥沙利铂+替吉奥(oxaliplatin plus tegafur,SOX)、奥沙利铂+5-氟尿嘧啶(oxaliplatin plus 5-fluorouracil,FOLFOX)]在改善预后方面差异无统计学意义(P=0.668)。结论:辅助化疗可改善GNEC患者预后,为临床决策提供参考。展开更多
The incidence rate of pancreatic neuroendocrine tumors(panNET)is increasing continuously.Curative resection was the primary treatment choice for panNET.However,till now,there were few studies concerning neo-adjuvant/c...The incidence rate of pancreatic neuroendocrine tumors(panNET)is increasing continuously.Curative resection was the primary treatment choice for panNET.However,till now,there were few studies concerning neo-adjuvant/conversion and adjuvant therapy for panNET.In this article,we reviewed the currently widely used medical treatments for advanced panNET.It seemed that peptide receptor radionuclide therapy(PRRT),chemotherapy(temozolomide-based or streptozocin-based)and sunitinib might be more effective to induce tumor shrinkage in panNET and therefore,these treatments could be tried in panNET when neo-adjuvant/conversion therapy was considered.As for adjuvant therapy,it was of great importance to identify patients with high risks of recurrence after curative surgery and previous studies found that high ki-67 index,large tumor size,lymphatic metastasis and perineural/vascular invasion,and so on,were correlated with early recurrence of panNET.Since PRRT and chemotherapy were more cytotoxic,these two kinds of therapies might be worth trying as adjuvant therapies in patients with high risks of recurrence after curative resection of panNET.Admittedly,no studies discussed in this review directly investigated neo-adjuvant/conversion and adjuvant therapy for panNET.Therefore,more prospective studies were still warranted.展开更多
文摘背景与目的:胃神经内分泌肿瘤(neuroendocrine neoplasm,NEN)是胃恶性肿瘤中一种较为罕见的类别,根据2019年世界卫生组织(World Health Organization,WHO)消化系统NEN的分类标准,分为分化好的神经内分泌瘤(neuroendocrine tumor,NET)和分化差的神经内分泌癌(neuroendocrine carcinoma,NEC)。目前,关于胃NEC(gastric NEC,GNEC)辅助化疗预后的研究匮乏,本研究旨在探讨辅助化疗能否使GNEC患者获益,以期为临床决策提供参考依据。方法:回顾性分析中山大学肿瘤防治中心、中山大学附属第一医院和复旦大学附属肿瘤医院2008年7月—2019年6月收治的184例GNEC患者的临床病理学资料,随访截至2022年5月31日。利用Kaplan-Meier法绘制生存曲线,根据单因素COX回归分析和多因素COX回归分析筛选出影响GNEC患者生存的独立预后因素,并进一步分析化疗、手术等因素对患者预后的影响。检验水准为α=0.05,所有统计学分析均使用SPSS 25.0软件。结果:单因素分析显示,手术(P<0.001)、化疗(P<0.001)、综合治疗模式(P<0.001)、N分期(P=0.029)、M分期(P<0.001)及TNM综合分期(P<0.001)是影响GNEC患者预后的变量。多因素COX回归分析显示,手术(P<0.001)、化疗(P<0.001)及M分期(P<0.001)是影响GNEC患者生存的独立预后因素。在所有患者中,TNMⅠ、Ⅱ、Ⅲ和Ⅳ期的3年累积生存率分别为51.9%、55.8%、40.7%和23.6%。在行根治性切除的患者中,辅助化疗可以改善GNEC患者的预后,辅助化疗和非辅助化疗的3年累积生存率分别为58.8%和33.3%(P=0.008)。分层分析结果显示,辅助化疗能够改善TNMⅡ(P=0.018)和Ⅲ期(P=0.023)患者的预后。此外,NEC化疗方案[依托泊苷+顺铂(etoposide plus cisplatin,EP)、伊立替康+顺铂(irinotecan plus cisplatin,IP)]与胃腺癌方案[奥沙利铂+卡培他滨(oxaliplatin plus capecitabine,XELOX)、奥沙利铂+替吉奥(oxaliplatin plus tegafur,SOX)、奥沙利铂+5-氟尿嘧啶(oxaliplatin plus 5-fluorouracil,FOLFOX)]在改善预后方面差异无统计学意义(P=0.668)。结论:辅助化疗可改善GNEC患者预后,为临床决策提供参考。
基金We thank the funding from Guangzhou Science and Technology Plan(201804010078).
文摘The incidence rate of pancreatic neuroendocrine tumors(panNET)is increasing continuously.Curative resection was the primary treatment choice for panNET.However,till now,there were few studies concerning neo-adjuvant/conversion and adjuvant therapy for panNET.In this article,we reviewed the currently widely used medical treatments for advanced panNET.It seemed that peptide receptor radionuclide therapy(PRRT),chemotherapy(temozolomide-based or streptozocin-based)and sunitinib might be more effective to induce tumor shrinkage in panNET and therefore,these treatments could be tried in panNET when neo-adjuvant/conversion therapy was considered.As for adjuvant therapy,it was of great importance to identify patients with high risks of recurrence after curative surgery and previous studies found that high ki-67 index,large tumor size,lymphatic metastasis and perineural/vascular invasion,and so on,were correlated with early recurrence of panNET.Since PRRT and chemotherapy were more cytotoxic,these two kinds of therapies might be worth trying as adjuvant therapies in patients with high risks of recurrence after curative resection of panNET.Admittedly,no studies discussed in this review directly investigated neo-adjuvant/conversion and adjuvant therapy for panNET.Therefore,more prospective studies were still warranted.
