Wada Ikuo, Shimizu Nobuyuki, Seto Yasuyuki
Department of Gastrointestinal Surgery, Graduate School of Medcine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Gan To Kagaku Ryoho. 2009 Oct;36(10):1606-10.
Neuroendocrine tumors of the digestive tract are relatively rare and comprise benign and malignant tumors. WHO classification system is based on recognized differences in morphology, function and clinical behavior. European Neuroendocrine Tumor Society(ENETS)proposed grading system and TNM classification system with disease staging for endocrine tumors of each organ which are both valid tools for prognostic stratification. The only curative therapy is the complete resection of the tumor. Endoscopic submucosal dissection(ESD)or local resection can be performed in low grade and early stage tumors; on the other hand, curative resection with lymph node dissection is recommended for neuroendocrine carcinoma. Complete surgical resection of liver metastases is associated with better long-term survival. Combination chemotherapy, such as Etoposide+Cisplatin/Carboplatin, is useful in treating unresected neuroendocrine carcinomas. Octreotide and Pasireotide (SOM230), somatostatin analogues, are reported to have the benefit of both hormonal symptom control and tumor growth suppression. Development of new effective drug is expected for the treatment of neuroendocrine tumors of the digestive tract.
消化道神经内分泌肿瘤相对罕见,包括良性和恶性肿瘤。世界卫生组织分类系统基于形态学、功能和临床行为方面已公认的差异。欧洲神经内分泌肿瘤学会(ENETS)提出了分级系统以及针对各器官内分泌肿瘤的疾病分期TNM分类系统,这两个系统都是用于预后分层的有效工具。唯一的根治性疗法是肿瘤的完整切除。对于低级别和早期肿瘤,可进行内镜黏膜下剥离术(ESD)或局部切除;另一方面,对于神经内分泌癌,建议进行根治性切除并清扫淋巴结。肝转移灶的完整手术切除与更好的长期生存率相关。联合化疗,如依托泊苷+顺铂/卡铂,可用于治疗无法切除的神经内分泌癌。据报道,生长抑素类似物奥曲肽和帕瑞肽(SOM230)在控制激素症状和抑制肿瘤生长方面均有益处。期待开发出新的有效药物用于治疗消化道神经内分泌肿瘤。