Schindl M, Kaserer K, Niederle B
Department of Surgery, Division of General Surgery, Section Endocrine Surgery University of Vienna Medical School, Währinger Gürtel 18-20, A 1090 Vienna, Austria.
Arch Surg. 2001 Jan;136(1):49-54. doi: 10.1001/archsurg.136.1.49.
Gastric neuroendocrine (or gastric carcinoid) tumors have recently been classified into 3 types that differ in biological behavior and prognosis. Although the necessity of type-adapted treatment is widely accepted, it seems inconsistently used in daily practice.
Diagnostic differentiation into various biological types is necessary for an adequate treatment of gastric neuroendocrine tumors.
Retrospective study.
University hospital department of surgery.
Twenty-seven patients with a histologically verified gastric neuroendocrine tumor.
A univariate analysis of survival rates with respect to tumor type, tumor biological parameters, and treatment performed was accomplished by applying the Kaplan-Meier estimation method. The log-rank test was used to evaluate the level of significance.
The 16 type 1 (59%) and 11 type 3 (41%) gastric neuroendocrine tumors differ in tumor size, histopathologic characteristics, and biological behavior. Nine (56%) of 16 type 1 gastric neuroendocrine tumors were treated by local excision, 8 of these (89%) had persistent atrophic gastropathy during the follow-up period. Five-year cumulative survival of patients with type 1 gastric neuroendocrine tumor was 100% without any progression into malignant phenotype. In contrast, 4 (44%) of 9 locally advanced type 3 gastric neuroendocrine tumors were treated radically by extended resection with a 5-year cumulative survival of 75%.
Differentiation into 3 biologically distinct tumor types for gastric neuroendocrine tumors is important with respect to therapeutic strategy and prognostic consideration. Correct diagnosis is attainable by using endoscopy, histopathologic characteristics, and laboratory chemical analysis and should precede any treatment. Extended radical surgery of high-risk type 3 tumors is indicated when definitive healing is achievable, whereas type 1 tumors are best treated by endoscopic removal and long-term follow-up.
胃神经内分泌（或胃类癌）肿瘤最近被分为3种类型，它们在生物学行为和预后方面存在差异。尽管根据肿瘤类型进行相应治疗的必要性已被广泛接受，但在日常实践中其应用似乎并不一致。
对胃神经内分泌肿瘤进行诊断性区分，分为不同的生物学类型，对于其恰当治疗是必要的。
回顾性研究。
大学医院外科。
27例经组织学证实的胃神经内分泌肿瘤患者。
采用Kaplan-Meier估计法对生存率进行单因素分析，分析内容包括肿瘤类型、肿瘤生物学参数以及所实施的治疗。采用对数秩检验评估显著性水平。
16例1型（59%）和11例3型（41%）胃神经内分泌肿瘤在肿瘤大小、组织病理学特征和生物学行为方面存在差异。16例1型胃神经内分泌肿瘤中有9例（56%）接受了局部切除，其中8例（89%）在随访期间存在持续性萎缩性胃炎。1型胃神经内分泌肿瘤患者的5年累积生存率为100%，未出现任何向恶性表型的进展。相比之下，9例局部进展期3型胃神经内分泌肿瘤中有4例（44%）接受了扩大切除术，5年累积生存率为75%。
对于胃神经内分泌肿瘤，区分3种生物学上不同的肿瘤类型对于治疗策略和预后考虑具有重要意义。通过内镜检查、组织病理学特征和实验室化学分析可实现正确诊断，且应在任何治疗之前进行。当有望实现根治时，对于高危3型肿瘤应进行扩大根治性手术，而1型肿瘤最好通过内镜切除并进行长期随访。
