Kidd Mark, Gustafsson Bjorn I
Department of Surgery, Yale University School of Medicine, PO Box 208602, New Haven, CT, USA.
Curr Gastroenterol Rep. 2012 Dec;14(6):467-72. doi: 10.1007/s11894-012-0289-x.
Gastric neuroendocrine neoplasms of the stomach can be divided into the usually well-differentiated, hypergastrinemia-dependent type I and II lesions and the more aggressively behaving gastrin-independent type III lesions. Mainly due to better diagnostics and awareness of this tumor, the observed incidence has increased more than tenfold over the last 30 years. Small (<15-20 mm) localized type I and II lesions that are slowly proliferating (Ki67<2%) can usually be managed conservatively with endoscopic surveillance. Reducing hypergastrinemia by surgical removal of an underlying gastrinoma is important in inhibiting growth and induce reduction of type II lesions, while the specific gastrin receptor antagonist YF476 or gastrin antibodies may become useful for both type I and II lesions. Infiltrating and metastasized tumors and type III lesions require a more aggressive approach with surgical resection and consideration of modalities such as somatostatin analogs, cytotoxics, and peptide receptor targeted treatment.
胃神经内分泌肿瘤可分为通常分化良好、依赖高胃泌素血症的I型和II型病变，以及行为更具侵袭性的不依赖胃泌素的III型病变。主要由于对该肿瘤的诊断水平提高和认识加深，在过去30年中观察到的发病率增加了十多倍。较小（<15 - 20毫米）、局限的、增殖缓慢（Ki67<2%）的I型和II型病变通常可通过内镜监测进行保守处理。通过手术切除潜在的胃泌素瘤来降低高胃泌素血症，对于抑制II型病变的生长和促使其缩小很重要，而特异性胃泌素受体拮抗剂YF476或胃泌素抗体可能对I型和II型病变均有用。浸润性和转移性肿瘤以及III型病变需要采取更积极的方法，包括手术切除，并考虑使用生长抑素类似物、细胞毒性药物和肽受体靶向治疗等方式。
