Liu Tao, Liu Ping, Wu Tao, Pan Yisheng, Chen Guowei, Wang Pengyuan, Jiang Yong, Wu Yingchao, Wang Xin
Department of General Surgery, Peking University First Hospital, Beijing 100034, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Sep 25;20(9):1015-1019.
To study the clinicopathologic characteristics and prognosis of rectal neuroendocrine neoplasms (NENs).
From January 2000 to May 2017, 84 patients were diagnosed as NENs by pathology and underwent surgical treatment in Peking University First Hospital. Their clinicopathological characteristics, surgial options and prognosis were analyzed retrospectively.
Among these 84 cases, 67 cases were NET G1, 6 cases were NET G2, 10 cases were NEC G3 and 1 case was MANEC G3. The median size was 0.8 (0.2 to 18.0) cm. There were 60 cases of stage I(, 2 cases of stage II(, 12 cases of stage III(, 10 cases of stage IIII(. Forty-nine patients accepted examinations because of non-specific symptoms, including altered bowel habits(22/49), bloody stool (19/49) and abdominal pain(10/49); the other 35 cases including 2 patients with liver metastasis were diagnosed by endoscopy or CT during routine physical examination. Forty-four patients received endoscopic ultrasonography(EUS) with 100% of sensitivity and 90.9% of accuracy. Among 20 cases (23.8%) with lymph node metastasis (all ≥T2 stage), 12 cases were NET G1 and G2 (1 case of multiple NET G1) and 8 cases were NEC G3 and MANEC G3. The lymph node metastasis rate of stage T1 NET G1 and G2 was lower than that of stage T2 to T4 NET G1 and G2, also lower than that of NEC G3 and MANEC G3 (all P=0.000), however, stage T2 to T4 NET G1 and G2 showed the similar rate of lymph node metastasis with NEC G3 and MANCE G3(P>0.05). Synchronously distant metastasis was found in 10 (11.9%) patients at the first diagnosis, and ovarian metastasis was found in 1 case 9 years after curative resection of rectal NEN. Among 81 patients receiving operation, 57 patients underwent endoscopic mucosal resection (56 patients of stage T1 NET G1 and G2); 3 patients local excision without lymph node dissection; 13 patients curative resection; 1 patient curative resection with liver metastasis resection; 6 patients palliative surgery and 1 patient metastatic lesion resection only. Overall follw-up time was 1 month to 169 months, and the 3- and 5-year survival rates were 87.7% and 79.7% respectively. No recurrence or metastasis was observed in all the 62 patients with T1 G1 and G2, including 56 cases of ESD, 3 cases of local excision, 3 cases of curative resection, whose 3-year and 5-year survival rates were both 96%. The prognosis was closely associated with grade and stage of NENs (all P=0.000).
The early symptoms of rectal NENs are insidious and atypical, therefore some patients are diagnosed as stage II( or higher at their first consultation. ESD is safe and effective for NET G1 and G2. The prognosis depends on grade and stage of NENs.
研究直肠神经内分泌肿瘤（NENs）的临床病理特征及预后。
2000年1月至2017年5月，北京大学第一医院84例经病理确诊为NENs并接受手术治疗的患者，对其临床病理特征、手术方式及预后进行回顾性分析。
84例患者中，67例为神经内分泌瘤G1（NET G1），6例为神经内分泌瘤G2（NET G2），10例为神经内分泌癌G3（NEC G3），1例为混合性神经内分泌-非神经内分泌癌G3（MANEC G3）。肿瘤中位大小为0.8（0.2至18.0）cm。Ⅰ期60例，Ⅱ期2例，Ⅲ期12例，Ⅳ期10例。49例因非特异性症状就诊，包括排便习惯改变（22/49）、便血（19/49）及腹痛（10/49）；其余35例包括2例肝转移患者在内，为常规体检行内镜或CT检查时发现。44例行超声内镜（EUS）检查，敏感性100%，准确性90.9%。20例（23.8%）发生淋巴结转移患者（均≥T2期）中，12例为NET G1和G2（1例为多发NET G1），8例为NEC G3和MANEC G3。T1期NET G1和G2的淋巴结转移率低于T2至T4期NET G1和G2，也低于NEC G3和MANEC G3（均P = 0.000），然而，T2至T4期NET G1和G2的淋巴结转移率与NEC G3和MANEC G3相似（P>0.05）。初诊时10例（11.9%）患者发现同时性远处转移，1例直肠NEN根治性切除9年后发现卵巢转移。81例接受手术患者中，57例行内镜黏膜切除术（56例为T1期NET G1和G2）；3例行局部切除未清扫淋巴结；13例行根治性切除；1例行根治性切除加肝转移灶切除；6例行姑息性手术；1例仅行转移灶切除。总随访时间1个月至169个月，3年和5年生存率分别为87.7%和79.7%。62例T1期G1和G2患者，包括56例内镜黏膜下剥离术（ESD）、3例局部切除、3例根治性切除患者，均无复发或转移，其3年和5年生存率均为96%。预后与NENs的分级及分期密切相关（均P = 0.000）。
直肠NENs早期症状隐匿且不典型，部分患者初诊时即为Ⅱ期或更高分期。ESD对NET G1和G2安全有效。预后取决于NENs的分级及分期。
