Kim Beom Su, Park Young Soo, Yook Jeong Hwan, Kim Byung-Sik
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea.
Therap Adv Gastroenterol. 2017 May;10(5):407-415. doi: 10.1177/1756283X17697870. Epub 2017 Mar 23.
We compared relapse-free survival (RFS) in gastric neuroendocrine carcinoma (WHO grade 3) and gastric carcinoma (GC). This is one of very few studies that compare the prognosis of poorly differentiated neuroendocrine carcinoma (WHO grade 3, G3 NEC) with that of GC.
Between 1996 and 2014, 63 patients were diagnosed with G3 NEC of the stomach and 56 with gastric neuroendocrine tumors (NETs) with GC at Asan Medical Center in Seoul, Korea. We also randomly selected 762 patients diagnosed with GC between 1999 and 2008.
Patients with G3 NEC tumors that invaded the muscularis propria or shallower had poorer RFS than those with GC of the same type, while G3 NEC that invaded the subserosa or deeper had similar RFS to GC of that type. Patients diagnosed with G3 NEC with N0 or N2 had poorer RFS than the corresponding patients with GC, while those who had G3 NEC with N1 or N3 had similar RFS to the corresponding patients with GC. G3 NEC patients had poorer RFS than well-differentiated, moderately differentiated and poorly differentiated GC patients, while G3 NEC patients had similar RFS to that of those with signet ring cell carcinoma (SRC). In addition, patients with G3 NEC of stages I or IIa had poorer RFS than those with corresponding GC, while G3 NEC stage IIb or greater had similar RFS to the corresponding GC.
Non-advanced G3 NEC showed poorer RFS than GC excluding SRC, while advanced G3 NEC has a similar RFS to that of GC without SRC. Therefore, we recommend that patients with non-advanced G3 NEC of the stomach be given a more aggressive treatment and surveillance than those with non-advanced GC excluding SRC.
我们比较了胃神经内分泌癌（世界卫生组织3级）和胃癌（GC）的无复发生存期（RFS）。这是为数不多的比较低分化神经内分泌癌（世界卫生组织3级，G3 NEC）与胃癌预后的研究之一。
1996年至2014年期间，韩国首尔峨山医学中心有63例患者被诊断为胃G3 NEC，56例被诊断为伴有GC的胃神经内分泌肿瘤（NETs）。我们还随机选择了1999年至2008年间762例被诊断为GC的患者。
肿瘤侵犯固有肌层或更浅层次的G3 NEC患者的RFS比相同类型的GC患者差，而侵犯浆膜下层或更深层次的G3 NEC患者的RFS与该类型的GC患者相似。诊断为N0或N2的G3 NEC患者的RFS比相应的GC患者差，而诊断为N1或N3的G3 NEC患者的RFS与相应的GC患者相似。G3 NEC患者的RFS比高分化、中分化和低分化GC患者差，而G3 NEC患者的RFS与印戒细胞癌（SRC）患者相似。此外，I期或IIa期G3 NEC患者的RFS比相应的GC患者差，而IIb期或更高分期的G3 NEC患者的RFS与相应的GC患者相似。
非进展期G3 NEC的RFS比不包括SRC的GC差，而进展期G3 NEC的RFS与不包括SRC的GC相似。因此，我们建议，与不包括SRC的非进展期GC患者相比，胃非进展期G3 NEC患者应接受更积极的治疗和监测。
