Objective:Quality assurance is crucial for oncological surgical treatment assessment.For rare diseases,singlequality indicators are not enough.We aim to develop a comprehensive and reproducible measurement,called the&...Objective:Quality assurance is crucial for oncological surgical treatment assessment.For rare diseases,singlequality indicators are not enough.We aim to develop a comprehensive and reproducible measurement,called the"Textbook Outcome"(TO),to assess the quality of surgical treatment and prognosis of gastric neuroendocrine carcinoma(G-NEC)patients.Methods:Data from patients with primary diagnosed G-NEC included in 24 high-volume Chinese hospitals from October 2005 to September 2018 were analyzed.TO included receiving a curative resection,≥15 lymph nodes examined,no severe postoperative complications,hospital stay≤21 d,and no hospital readmission≤30 d after discharge.Hospital variation in TO was analyzed using a case mix-adjusted funnel plot.Prognostic factors of survival and risk factors for non-Textbook Outcome(non-TO)were analyzed using Cox and logistic models,respectively.Results:TO was achieved in 56.6%of 860 G-NEC patients.TO patients had better overall survival(OS),disease-free survival(DFS),and recurrence-free survival(RFS)than non-TO patients(P<0.05).Moreover,TO patients accounted for 60.3%of patients without recurrence.Multivariate Cox analysis revealed non-TO as an independent risk factor for OS,DFS,and RFS of G-NEC patients(P<0.05).Increasing TO rates were associated with improved OS for G-NEC patients,but not hospital volume.Multivariate logistic regression revealed that nonlower tumors,open surgery,and>200 mL blood loss were independent risk factors for non-TO patients(P<0.05).Conclusions:TO is strongly associated with multicenter surgical quality and prognosis for G-NEC patients.Factors predicting non-TO are identified,which may help guide strategies to optimize G-NEC outcomes.展开更多
BACKGROUND Gastric stump cancer,also known as gastric remnant cancer(GRC),is one of the main complications of postgastrectomy syndrome,which usually occurs following Billroth II reconstruction.The predominant histolog...BACKGROUND Gastric stump cancer,also known as gastric remnant cancer(GRC),is one of the main complications of postgastrectomy syndrome,which usually occurs following Billroth II reconstruction.The predominant histological subtype of GRC is adenocarcinoma,whereas neuroendocrine carcinoma is relatively rare.In particular,there are few recently reported cases of mixed neuroendocrine carcinoma(MNEC)in the English literature.Here,we present an extremely rare case of MNEC of the gastric stump.CASE SUMMARY A 59-year-old patient presented to our department owing to chronic constipation.He had undergone subtotal gastric resection 35 years prior to admission because of benign peptic ulcer.After admission,the patient underwent several tests,and gastroendoscopy showed evidence of Billroth II gastrectomy and local thickening of the gastric stump mucosa at the gastrojejunostomy site,with bile reflux;pathological biopsy revealed adenocarcinoma.He was then diagnosed with GRC and underwent total gastrectomy,D2 Lymphadenectomy,and esophagojejunal Roux-en-Y reconstruction.Histopathological examination of the specimen identified MNEC comprising MNEC(60%),adenocarcinoma(30%),and squamous cell carcinoma(10%).Postoperative adjuvant chemotherapy was initiated on September 17,2020.Taxol plus cisplatin was administered for only one cycle because of severe liver function damage,and the regimen was changed to etoposide plus cisplatin on October 10,2020 for five cycles.The patient recovered,with no recurrence after 6 mo of follow-up.CONCLUSION Gastric MNECs(GMNECs)is a rare type of GRC.This study presented the unusual occurrence of GMNEC in the gastric stump.This case will contribute to improvements in our understanding of the carcinogenesis,biology,pathology,and behavior of GMNEC and GRC.展开更多
Gastric neuroendocrine neoplasms(g-NENs)or neuroendocrine tumors are generally slow-growing tumors with increasing incidence.They arise from enterochromaffin like cells and are divided into four types according to cli...Gastric neuroendocrine neoplasms(g-NENs)or neuroendocrine tumors are generally slow-growing tumors with increasing incidence.They arise from enterochromaffin like cells and are divided into four types according to clinical characteristic features.Type 1 and 2 are gastrin dependent,whereas type 3 and 4 are sporadic.The reason for hypergastrinemia is atrophic gastritis in type 1,and gastrin releasing tumor(gastrinoma)in type 2 g-NEN.The diagnosis of g-NENs needs histopathological investigation taken by upper gastrointestinal endoscopy.g-NENs are positively stained with chomogranin A and synaptophysin.Grading is made with mitotic index and ki-67 proliferation index on histopathological analysis.It is crucial to discriminate between types of g-NENs,because the management,treatment and prognosis differ significantly between subtypes.Treatment options for g-NENs include endoscopic resection,surgical resection with or without antrectomy,medical treatment with somatostatin analogues,netazepide or chemotherapy regimens.Follow-up without excision is another option in appropriate cases.The prognosis of type 1 and 2 g-NENs are good,whereas the prognosis of type 3 and 4 g-NENs are close to the prognosis of gastric adenocancer.展开更多
基金supported by scientific and technological innovation joint capital projects of Fujian province(No.2018Y9041)National Natural Science Foundation of China(No.82002462)+2 种基金China Scholarship Council(No.201908350095)Provincial Natural Science Foundation Project(No.2020J011001)Fujian Medical University Outstanding Young Cultivation Project(No.2020PYY002)。
文摘Objective:Quality assurance is crucial for oncological surgical treatment assessment.For rare diseases,singlequality indicators are not enough.We aim to develop a comprehensive and reproducible measurement,called the"Textbook Outcome"(TO),to assess the quality of surgical treatment and prognosis of gastric neuroendocrine carcinoma(G-NEC)patients.Methods:Data from patients with primary diagnosed G-NEC included in 24 high-volume Chinese hospitals from October 2005 to September 2018 were analyzed.TO included receiving a curative resection,≥15 lymph nodes examined,no severe postoperative complications,hospital stay≤21 d,and no hospital readmission≤30 d after discharge.Hospital variation in TO was analyzed using a case mix-adjusted funnel plot.Prognostic factors of survival and risk factors for non-Textbook Outcome(non-TO)were analyzed using Cox and logistic models,respectively.Results:TO was achieved in 56.6%of 860 G-NEC patients.TO patients had better overall survival(OS),disease-free survival(DFS),and recurrence-free survival(RFS)than non-TO patients(P<0.05).Moreover,TO patients accounted for 60.3%of patients without recurrence.Multivariate Cox analysis revealed non-TO as an independent risk factor for OS,DFS,and RFS of G-NEC patients(P<0.05).Increasing TO rates were associated with improved OS for G-NEC patients,but not hospital volume.Multivariate logistic regression revealed that nonlower tumors,open surgery,and>200 mL blood loss were independent risk factors for non-TO patients(P<0.05).Conclusions:TO is strongly associated with multicenter surgical quality and prognosis for G-NEC patients.Factors predicting non-TO are identified,which may help guide strategies to optimize G-NEC outcomes.
文摘BACKGROUND Gastric stump cancer,also known as gastric remnant cancer(GRC),is one of the main complications of postgastrectomy syndrome,which usually occurs following Billroth II reconstruction.The predominant histological subtype of GRC is adenocarcinoma,whereas neuroendocrine carcinoma is relatively rare.In particular,there are few recently reported cases of mixed neuroendocrine carcinoma(MNEC)in the English literature.Here,we present an extremely rare case of MNEC of the gastric stump.CASE SUMMARY A 59-year-old patient presented to our department owing to chronic constipation.He had undergone subtotal gastric resection 35 years prior to admission because of benign peptic ulcer.After admission,the patient underwent several tests,and gastroendoscopy showed evidence of Billroth II gastrectomy and local thickening of the gastric stump mucosa at the gastrojejunostomy site,with bile reflux;pathological biopsy revealed adenocarcinoma.He was then diagnosed with GRC and underwent total gastrectomy,D2 Lymphadenectomy,and esophagojejunal Roux-en-Y reconstruction.Histopathological examination of the specimen identified MNEC comprising MNEC(60%),adenocarcinoma(30%),and squamous cell carcinoma(10%).Postoperative adjuvant chemotherapy was initiated on September 17,2020.Taxol plus cisplatin was administered for only one cycle because of severe liver function damage,and the regimen was changed to etoposide plus cisplatin on October 10,2020 for five cycles.The patient recovered,with no recurrence after 6 mo of follow-up.CONCLUSION Gastric MNECs(GMNECs)is a rare type of GRC.This study presented the unusual occurrence of GMNEC in the gastric stump.This case will contribute to improvements in our understanding of the carcinogenesis,biology,pathology,and behavior of GMNEC and GRC.
文摘Gastric neuroendocrine neoplasms(g-NENs)or neuroendocrine tumors are generally slow-growing tumors with increasing incidence.They arise from enterochromaffin like cells and are divided into four types according to clinical characteristic features.Type 1 and 2 are gastrin dependent,whereas type 3 and 4 are sporadic.The reason for hypergastrinemia is atrophic gastritis in type 1,and gastrin releasing tumor(gastrinoma)in type 2 g-NEN.The diagnosis of g-NENs needs histopathological investigation taken by upper gastrointestinal endoscopy.g-NENs are positively stained with chomogranin A and synaptophysin.Grading is made with mitotic index and ki-67 proliferation index on histopathological analysis.It is crucial to discriminate between types of g-NENs,because the management,treatment and prognosis differ significantly between subtypes.Treatment options for g-NENs include endoscopic resection,surgical resection with or without antrectomy,medical treatment with somatostatin analogues,netazepide or chemotherapy regimens.Follow-up without excision is another option in appropriate cases.The prognosis of type 1 and 2 g-NENs are good,whereas the prognosis of type 3 and 4 g-NENs are close to the prognosis of gastric adenocancer.