ENETS Neuroendocrine Centre of Excellence, Institute of Liver studies, Kings College Hospital, London, UK.
Aliment Pharmacol Ther. 2014 May;39(10):1071-84. doi: 10.1111/apt.12698. Epub 2014 Mar 13.
Gastric carcinoids (GCs) or neuroendocrine tumours (NETs) are increasingly identified at endoscopy, and account for 0.6-2% of all gastric polyps identified. The SEER database in the US has demonstrated a rising incidence of gastric NETs amongst all NETs; from 2.2% between 1950 and 1969 to 6.0% between 2000 and 2007.
To review the literature and assist clinicians in managing patients with GCs.
A literature search was conducted through MEDLINE using search terms: gastric, carcinoid, neuroendocrine tumour, therapy, endoscopy, mucosal resection, submucosal dissection. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles.
There are three types of GCs with important epidemiological, pathophysiological, histological and endoscopic differences that affect prognosis and management. Type 1 and 2 GCs develop in the context of hypergastrinaemia that originates from achlorhydria in atrophic gastritis and a gastrinoma, respectively. Type 3 GCs occur sporadically and independent of gastrin. The histological type, grade and Ki67 index are used to determine prognosis and direct clinical management. Type 1 GCs >1 cm in size and type 2 GCs should be assessed for invasion beyond the submucosa with EUS prior to endoscopic resection with EMR or ESD. Type 3 GCs should be managed as per recommendations for gastric adenocarcinoma. The treatment of advanced disease is multimodal.
Patients with gastric carcinoids should be discussed in a specialist neuroendocrine tumour multidisciplinary meeting to ensure all treatment options are explored in localised and advanced disease. Areas of controversy exist that need further research.
胃类癌（GCs）或神经内分泌肿瘤（NETs）在胃镜检查中越来越常见，占所有胃息肉的 0.6-2%。美国的 SEER 数据库显示，胃 NETs 在所有 NETs 中的发病率呈上升趋势；从 1950 年至 1969 年的 2.2%上升到 2000 年至 2007 年的 6.0%。
回顾文献并协助临床医生管理 GCs 患者。
通过 MEDLINE 使用搜索词进行文献检索：胃、类癌、神经内分泌肿瘤、治疗、内镜、黏膜切除术、黏膜下剥离术。通过手动审查确定相关文章。审查这些文章的参考文献，以包括进一步的适当文章。
有三种类型的 GCs，具有重要的流行病学、病理生理学、组织学和内镜差异，这些差异影响预后和管理。1 型和 2 型 GCs 分别在萎缩性胃炎和胃泌素瘤引起的胃酸缺乏和高胃泌素血症的背景下发展。3 型 GCs 偶发发生，与胃泌素无关。组织学类型、分级和 Ki67 指数用于确定预后并指导临床管理。大小>1cm 的 1 型 GCs 和 2 型 GCs 应在 EMR 或 ESD 内镜切除前行 EUS 评估是否侵犯黏膜下。3 型 GCs 应按胃腺癌的建议进行治疗。晚期疾病的治疗是多模式的。
胃类癌患者应在神经内分泌肿瘤多学科会议上进行讨论，以确保在局部和晚期疾病中探讨所有治疗选择。存在需要进一步研究的争议领域。
