Borch Kurt, Ahrén Bo, Ahlman Håkan, Falkmer Sture, Granérus Göran, Grimelius Lars
Department of Surgery, University Hospital of Linköping, Linköping, Sweden.
Ann Surg. 2005 Jul;242(1):64-73. doi: 10.1097/01.sla.0000167862.52309.7d.
To analyze tumor biology and the outcome of differentiated treatment in relation to tumor subtype in patients with gastric carcinoid.
Gastric carcinoids may be subdivided into ECL cell carcinoids (type 1 associated with atrophic gastritis, type 2 associated with gastrinoma, type 3 without predisposing conditions) and miscellaneous types (type 4). The biologic behavior and prognosis vary considerably in relation to type.
A total of 65 patients from 24 hospitals (51 type 1, 1 type 2, 4 type 3, and 9 type 4) were included. Management recommendations were issued for newly diagnosed cases, that is, endoscopic or surgical treatment of type 1 and 2 carcinoids (including antrectomy to abolish hypergastrinemia) and radical resection for type 3 and 4 carcinoids.
Infiltration beyond the submucosa occurred in 9 of 51 type 1, 4 of 4 type 3, and 7 of 9 type 4 carcinoids. Metastases occurred in 4 of 51 type 1 (3 regional lymph nodes, 1 liver), the single type 2 (regional lymph nodes), 3 of 4 type 3 (all liver), and 7 of 9 type 4 carcinoids (all liver). Of the patients with type 1 carcinoid, 3 had no specific treatment, 40 were treated with endoscopic or surgical excision (in 10 cases combined with antrectomy), 7 underwent total gastrectomy, and 1 underwent proximal gastric resection. Radical tumor removal was not possible in 2 of 4 patients with type 3 and 7 of 9 patients with type 4 carcinoid. Five- and 10-year crude survival rates were 96.1% and 73.9% for type 1 (not different from the general population), but only 33.3% and 22.2% for type 4 carcinoids.
Subtyping of gastric carcinoids is helpful in the prediction of malignant potential and long-term survival and is a guide to management. Long-term survival did not differ from that of the general population regarding type 1 carcinoids but was poor regarding type 4 carcinoids.
分析胃类癌患者的肿瘤生物学特性以及与肿瘤亚型相关的差异化治疗结果。
胃类癌可分为肠嗜铬样（ECL）细胞类癌（1型与萎缩性胃炎相关，2型与胃泌素瘤相关，3型无 predisposing 条件）和其他类型（4型）。其生物学行为和预后因类型而异。
纳入来自24家医院的65例患者（51例1型、1例2型、4例3型和9例4型）。针对新诊断病例发布管理建议，即对1型和2型类癌进行内镜或手术治疗（包括切除胃窦以消除高胃泌素血症），对3型和4型类癌进行根治性切除。
51例1型类癌中有9例、4例3型类癌中有4例、9例4型类癌中有7例发生黏膜下层以外浸润。51例1型类癌中有4例发生转移（3例区域淋巴结转移、1例肝转移），唯一的1例2型类癌发生区域淋巴结转移，4例3型类癌中有3例发生转移（均为肝转移），9例4型类癌中有7例发生转移（均为肝转移）。1型类癌患者中，3例未接受特殊治疗，40例接受内镜或手术切除（10例联合胃窦切除术），7例行全胃切除术，1例行近端胃切除术。4例3型类癌患者中有2例、9例4型类癌患者中有7例无法实现肿瘤根治性切除。1型类癌的5年和10年粗生存率分别为96.1%和73.9%（与普通人群无差异），但4型类癌仅为33.3%和22.2%。
胃类癌的分型有助于预测恶性潜能和长期生存，是治疗的指导依据。1型类癌的长期生存率与普通人群无差异，但4型类癌较差。
