摘要
目的探讨胃肠胰神经内分泌肿瘤（GEP-NEN）的临床病理特征，筛选转移危险因素，分析其诊治和预后。方法回顾性分析2010年1月至2015年11月收治的405例GEP-NEN的病历资料，将GEP-NEN分为神经内分泌瘤（NET，G1和G2级）、神经内分泌癌（NEC，G3级）和混合性腺神经内分泌癌（MANEC，G3级）。采用免疫组织化学法分析肿瘤组织突触素、嗜铬粒蛋白A（CgA）和CD56的染色特征。采用卡方检验、t检验分析各组间的病理特征差异，Logistic回归分析转移危险因素，Kaplan-Meier法和Log-rank检验进行生存分析。结果GEP-NEN患者平均年龄为（54.7±13.3）岁。胃NEN 98例（24.2%），其次为直肠NEN 95例（23.5%），胰腺NEN 86例（21.2%），食管NEN 50例（12.3%）。其中47例（11.6%）为功能性GEP-NEN，358例（88.4%）为非功能性。根据病理诊断结果，NET 227例（56.0%），NEC 125例（30.9%），MANEC 16例（4.0%）；肿瘤分级G1级120例（29.6%）、G2级108例（26.7%）、G3级177例（43.7%）。突触素、CgA、CD56的免疫组织化学染色阳性率分别为97.4%（381/391）、44.0%（121/275）、83.9%（291/347）；G1、G2、G3级肿瘤最大径中位数（下四分位数，上四分位数）分别为1.0 cm（0.6 cm, 1.5 cm）、1.5 cm（1.0 cm, 2.5 cm）、4.0 cm（2.5 cm, 6.0 cm），三者差异有统计学意义（Z＝99.171，P〈0.01）；G3级CgA阳性率低于G1和G2级，差异均有统计学意义（χ2＝7.078、11.391，P均〈0.01）。ROC曲线显示，肿瘤最大径预测肿瘤转移可信度高（AUC值为0.836，95%CI为0.782～0.890，P〈0.01）。G3级转移组与未转移组的中位生存时间分别为12.0和41.5月，Log-rank检验二者生存曲线差异有统计学意义（χ2＝37.075，P〈0.01）。结论GEP-NEN可发生于消化系统任何部位。不同病理分级的肿瘤大小、免疫组织化学染色阳性率、所在原发部位存在差异。肿瘤最大径和肿瘤分级是转移的重要预测�
ObjectiveTo explore the clinicopathologic characteristics, to screen risk factors of metastasis and to analyze the diagnosis, treatment and prognosis of gastroenteropancreatic neuroendocrine neoplasm （GEP-NEN）.MethodsFrom January 2010 to November 2015, the clinical data of 405 patients with GEP-NEN were retrospectively analyzed. GEP-NEN tumors were classified as neuroendocrine tumor （NET, G1 and G2 grade）, neuroendocrine carcinoma （NEC, G3 grade） and mixed adenoendocrine carcinoma （MANEC, G3 grade）. The clinicopathologic characteristics were summarized. The staining characteristics of synaptophysin （Syn）, chromogranin A （CgA） and CD56 of tumor tissues were analyzed by immunohistochemistry.χ2 and t test were performed to analyze differences in pathologic characteristics between groups. Logistics regression method was used to analyze the risk factors of metastasis. Kaplan-Meier method and Log-rank test were used for survival analysis.ResultsThe mean age of patients with GEP-NEN was （54.7±13.3） years. Gastric NEN was the most common GEP-NEN （98 cases, 24.2%）, followed by 95 cases （23.5%） with NEN in rectum, 86 cases （21.2%） in pancreas and 50 cases （12.3%） in esophagus. Among them, 47 cases （11.6%） were functional GEP-NEN and 358 cases （88.4%） were non-functional GEP-NEN. According to pathologic diagnosis, 227 cases （56.0%） were NET, 125 cases （30.9%） were NEC and 16 cases （4.0%） were MANEC. According to tumor classification, 120 cases （29.6%） were grade G1, 108 cases （26.7%） were grade G2 and 177 cases （43.7%） were grade G3. Immunohistochemistry staining positive rates of Syn, CgA and CD56 were 97.4%（381/391）, 44.0%（121/275） and 83.9%（291/347）, respectively. The median （lower quartile, upper quartile） diameter of grade G1, G2 and G3 tumors were 1.0 cm （0.6 cm, 1.5 cm）, 1.5 cm （1.0 cm, 2.5 cm）, 4.0 cm（2.5 cm, 6.0 cm）, respectively, and the difference was statistically significant （Z=99.171, P〈0.01）. The po
出处
《中华消化杂志》
CAS
CSCD
北大核心
2016年第12期816-821,共6页
Chinese Journal of Digestion
基金
国家自然科学基金（81001103、81472325）
关键词
神经内分泌瘤
癌
神经内分泌
病理学
肿瘤转移
预后
Neuroendocrine tumors
Carcinoma, neuroendocrine
Pathology
Neoplasm metastasis
Prognosis
