摘要
目的:探讨结直肠神经内分泌肿瘤(colorectal neuroendocrine neoplasms,CRNENs)的临床病理特征和预后因素。方法:根据消化系统肿瘤世界卫生组织(WHO)分类第5版中NENs的分类标准回顾性研究2011年3月至2020年12月于天津医科大学肿瘤医院行根治性手术和局部切除的185例CRNENs,比较不同分类CRNENs的临床病理特征,并进行生存分析。结果:CRNENs中,神经内分泌瘤(neuroendocrine tumor,NET)G1、NET G2、NET G3、神经内分泌癌(neuroendocrine carcinoma,NEC)和混合性神经内分泌-非神经内分泌肿瘤(mixed neuroendocrine-non-neuroendocrine neoplasm,MiNEN)分别为142例(76.8%)、18例(9.7%)、3例(1.6%)、14例(7.6%)、8例(4.3%)。临床病理特征方面,CRNENs分级越高,肿瘤直径越大,淋巴结转移越多见,诊断时进展期患者的比例越高(均P<0.05);但个别NET G1、G2也存在侵袭性生物学行为和淋巴结或远处转移。NEC的Ki-67指数的平均值显著高于NET G3(t=5.569,P<0.001)。不同WHO分类患者的总体生存(overall survival,OS)和无进展生存(progression-free survival,PFS)差异具有统计学意义(均P<0.05)。结论:结直肠NENs是一组异质性肿瘤,但是无论分类如何,CRNENs均为恶性,需要结合临床分期等情况决定治疗方式。CRNENs的发病机制未明,一些NET G3与NEC鉴别诊断困难,NET G3、MiNEN仍缺乏统一的治疗标准,需要多中心大样本研究来完善诊疗标准。
Objective:To identify clinicopathological characteristics and prognostic factors of colorectal neuroendocrine neoplasms(CRNENs).Methods:Based on the classification criteria of neuroendocrine neoplasms in the fifth edition of the World Health Organization(WHO)classification of the digestive system,185 cases of CRNENs undergoing radical surgery and local resection at Tianjin Medical University Cancer Institute&Hospital between March 2011 and December 2020 were studied retrospectively.Clinicopathological characteristics were compared among different grades of CRNENs,and survival analysis of all cases and each grade was performed.Result:The entire cohort comprised 142 cases(76.8%)of neuroendocrine tumor(NET)G1,18 cases(9.7%)of NET G2,3 cases(1.6%)of NET G3,14 cases(7.6%)of neuroendocrine carcinoma(NEC),and 8 cases(4.3%)of mixed neuroendocrine-non-neuroendocrine neoplasms(MiNEN).Patients with higher-grade CRNENs tended to exhibit metastasis to regional lymph nodes and have larger tumor diameter.When diagnosed,most patients were in the advanced disease stages(P<0.05 for all).However,individual NET G1/G2 also exhibited aggressive biological behavior and lymph node or distant metastasis.Ki-67 index in NEC was significantly higher than that in NET G3(t=5.569,P<0.001).The overall survival(OS)and progression-free survival(PFS)of patients with different WHO classifications were significantly different(P<0.05 for all).Conclusions:CRNENs are heterogeneous tumors;however,regardless of grade,CRNENs are malignant and require a combination of clinical stage and other conditions to decide the treatment modality.Since,the pathogenesis of CRNENs is unknown,the differential diagnosis between NET G3 and NEC is difficult;furthermore,uniform treatment criteria for NET G3 and MiNEN are inadequate.Thus,multicenter large-sample studies to improve the diagnosis and treatment are required.
作者
陈浩竹
张靖宜
陈帅
郭玉虹
罗烨
丁婷婷
孙燕
Haozhu Chen;Jingyi Zhang;Shuai Chen;Yuhong Guo;Ye Luo;Tingting Ding;Yan Sun(Department of Pathology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2022年第2期69-75,共7页
Chinese Journal of Clinical Oncology
基金
国家自然科学基金面上项目(编号:81871990)资助。
关键词
结直肠
神经内分泌肿瘤
分类
预后
colorectal neuroendocrine neoplasms(CRNENs)
neuroendocrine tumor(NET)
classification
prognosis
