摘要
目的总结原发性肝脏神经内分泌肿瘤(PHNET)临床特征、诊治经验及分析预后影响因素。方法回顾分析郑州大学第一附属医院2012年1月至2019年1月连续收治的21例PHNET患者临床资料,其中男性11例,女性10例,年龄36~75岁。临床病理指标与预后的关系采用log-rank检验进行单因素分析,多因素分析采用Cox比例风险模型。结果21例PHNET患者上腹部疼痛10例,腹痛伴恶心、呕吐3例,腹胀5例,无症状3例。糖类抗原(CA)19-9升高6例,CA125升高7例。腹部增强CT均显示肝脏实性占位,单发4例,多发17例,平均直径58 mm。淋巴结转移14例。行根治性肝切除术5例,经导管肝动脉栓塞化疗+化疗2例,仅化疗12例,支持治疗2例。是否手术切除、肿瘤分级、细胞角蛋白阳性与否、有无淋巴结转移与PHNET患者预后有关。多因素Cox回归分析,其他治疗(朋=8.99,95%Cf:1.13~71.80)是PHNET患者预后的独立危险因素,手术切除患者预后更佳。结论PHNET临床表现无特异性,治疗首选手术切除。手术切除影响患者预后,手术切除预后更佳。
Objective To analyze the clinical characteristics,diagnosis,treatment and prognostic factors of primary hepatic neuroendocrine tumor(PHNET).Methods To analyze the clinical data of 21 patients with PHNET who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2019.There were 11 males and 10 females,with ages which ranged from 36 to 75 years.Log-rank test was used for single-factor analysis of the relationship behveen clinical and pathological indicators and prognosis.Cox proportional risk model was used for multi-factor analysis.Results Among the 21 PHNET patients,10 presented with central and upper abdominal pain,3 abdominal pain accompanied by nausea and vomiting,5 abdominal distension,and 3 were asymptomatic.Carbohydrate antigen(CA)19-9 was elevated in 6 patients and CA125 in 7 patients.Abdominal enhanced CT showed solid liver space occupying lesions.Four patients had solitary and 17 had multiple lesions.The mean diameter was 58 mm.Fourteen patients had lymph node metastasis.Five patients underwent radical hepatectomy,2 transcatheter hepatic arterial chemoembolization+chemotherapy,12 chemotherapy,and 2 supportive treatment.Factors which were associated with prognosis of PHNET patients were surgery,tumor grading,cytokeratin positivity and lymph node metastasis.Multivariate Cox regression analysis showed that inoperability(HR=8.99,95%CI:1.13-71.80)was an independent risk factor of prognosis of PHNET patients.The prognosis in patients who underwent surgical resection was better.Conclusion Patients with PHNET had no specific clinical manifestations.Surgical resection gave the best results in treatment.As surgical resection affected prognosis,it should be carried out if technically feasible.
作者
冯伟
周梦豪
张坦
余祖启
李珠银
赵龙栓
Feng Wei;Zhou Menghao;Zhang Tan;Yu Zuqi;Li Zhuyin;Zhao Longshuan(Department of Hepatobiliary and Pancreatic Surgery,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2020年第1期19-21,共3页
Chinese Journal of Hepatobiliary Surgery
关键词
预后
原发性肝脏神经内分泌肿瘤
临床特征
影响因素
Diagnosis
Primary liver neuroendocrine tumor
Clinical characteristics
Influencing factor
