Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology and Translational Genomics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
Br J Surg. 2018 Oct;105(11):1480-1486. doi: 10.1002/bjs.10901. Epub 2018 Jun 12.
With the widespread use of endoscopy, small and low-grade type 3 gastric neuroendocrine tumours (NETs) are increasingly being detected. The clinicopathological features, biological behaviour and appropriate treatment strategy for these NETs remain unclear.
Patients with biopsy-proven gastric NET and a normal fasting serum gastrin level were identified from a prospectively maintained database. Clinicopathological features and long-term outcome of local resection for type 3 NETs were reviewed retrospectively and compared according to tumour grade.
Some 32 patients with type 3 gastric NETs were included (25 patients with NET grade G1, 5 with G2 and 2 with G3). Pathological tumour size was 2·0 cm or less in 30 patients. All tumours were well differentiated, even G3 lesions, and all tumours but one were confined to the submucosal layer. G1 NETs were significantly smaller and had a significantly lower lymphovascular invasion rate than G2 and G3 NETs. Twenty-two patients with a G1 NET without lymphovascular invasion were treated with wedge or endoscopic resection. After a median follow-up of 59 (range 6-102) months, no patient with a G1 NET of 1·5 cm or smaller developed recurrence and one patient with a G1 NET larger than 1·5 cm had recurrence in a perigastric lymph node. Among seven patients with a G2 or G3 NET, two had lymph node metastasis and one had liver metastases.
Low-grade type 3 gastric NET has non-aggressive features and a favourable prognosis. Wedge or endoscopic resection may be a valid option for patients with type 3 gastric G1 NET no larger than 1·5 cm without lymphovascular invasion.
随着内镜的广泛应用，越来越多的小且低级别 3 型胃神经内分泌肿瘤（NET）被发现。这些 NET 的临床病理特征、生物学行为及适当的治疗策略仍不清楚。
从一个前瞻性维护的数据库中确定了经活检证实的胃 NET 且空腹血清胃泌素水平正常的患者。回顾性分析并比较了根据肿瘤分级的 3 型 NET 局部切除的临床病理特征和长期结果。
共纳入 32 例 3 型胃 NET 患者（25 例 NET 分级 G1、5 例 G2 和 2 例 G3）。30 例患者的肿瘤大小均为 2.0cm 或更小。所有肿瘤均为高分化，甚至 G3 病变，且所有肿瘤均局限于黏膜下层，无一例侵犯固有肌层。G1 NET 的肿瘤直径明显小于 G2 和 G3 NET，且 G1 NET 的脉管侵犯率明显低于 G2 和 G3 NET。22 例无脉管侵犯的 G1 NET 患者接受楔形或内镜切除治疗。中位随访 59（范围 6-102）个月后，无 1.5cm 或更小的 G1 NET 患者复发，1 例 G1 NET 大于 1.5cm 的患者在胃周淋巴结复发。7 例 G2 或 G3 NET 患者中，2 例发生淋巴结转移，1 例发生肝转移。
低级别 3 型胃 NET 具有非侵袭性特征和良好的预后。对于无脉管侵犯且直径不超过 1.5cm 的 3 型胃 G1 NET 患者，楔形或内镜切除可能是一种有效的选择。
