Department of Surgical Oncology, University Medical Center Utrecht, The Netherlands.
Department of Surgical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur J Surg Oncol. 2018 Dec;44(12):1955-1962. doi: 10.1016/j.ejso.2018.07.058. Epub 2018 Aug 2.
The aim of this study is to provide insight in accuracy of diagnosing, current treatment and survival in patients with resectable esophageal and gastric neuroendocrine- and mixed adenoneuroendocrine carcinomas (NEC, MANEC).
All patients with esophageal or gastric (MA)NEC, who underwent surgical resection between 2006 and 2016, were identified from the Dutch national registry for histo- and cytopathology (PALGA). Patients with a neuroendocrine tumor lower than grade 3 were excluded. Data on patients, treatment and outcomes were retrieved from the patient records. Diagnosis by endoscopic biopsy was compared with diagnosis by resection specimen. Kaplan Meier survival analysis was performed.
A total of 49 patients were identified in 25 hospitals, including 21 patients with esophageal (MA)NEC and 26 patients with gastric (MA)NEC on resection specimen. Biopsy diagnosis of (MA)NEC was correct in 23/27 patients. However, 20/47 patients with definitive diagnosis of (MA)NEC, were misdiagnosed on biopsy. Neoadjuvant therapy was administered in 13 (62%) esophageal (MA)NECs and 12 (46%) gastric (MA)NECs. Survival curves were similar with and without neoadjuvant therapy. One (4.8%) esophageal (MA)NEC and 4 (15%) gastric (MA)NECs died within 90 days postoperatively. For esophageal (MA)NEC the median overall survival (OS) after surgery was 37 months and 1-, 3- and 5-year OS were 71%, 50% and 35%, respectively. For gastric (MA)NEC, the median OS was 23 months and 1-, 3- and 5-year OS were 62%, 50% and 39%, respectively.
Localized esophageal and gastric (MA)NEC are often misdiagnosed on endoscopic biopsies. After resection, long-term survival was achieved in respectively 35% and 39% of patients.
本研究旨在深入了解可切除食管和胃神经内分泌癌（NEC）和混合性腺神经内分泌癌（MANEC）患者的诊断准确性、当前治疗方法和生存情况。
从荷兰组织病理学和细胞病理学全国登记处（PALGA）中确定了 2006 年至 2016 年间接受手术切除的所有食管或胃（MA）NEC 患者。排除了神经内分泌肿瘤分级低于 3 级的患者。从患者病历中检索了患者、治疗和结局数据。通过内镜活检和切除标本诊断进行比较。进行 Kaplan-Meier 生存分析。
在 25 家医院共确定了 49 例患者，包括 21 例食管（MA）NEC 和 26 例胃（MA）NEC 患者。在 27 例患者中，23 例通过内镜活检正确诊断为（MA）NEC。然而，在 47 例明确诊断为（MA）NEC 的患者中，有 20 例在活检时被误诊。13 例（62%）食管（MA）NEC 和 12 例（46%）胃（MA）NEC 接受了新辅助治疗。有和没有新辅助治疗的生存曲线相似。1 例（4.8%）食管（MA）NEC 和 4 例（15%）胃（MA）NEC 在术后 90 天内死亡。食管（MA）NEC 手术后的中位总生存期（OS）为 37 个月，1、3 和 5 年的 OS 分别为 71%、50%和 35%。胃（MA）NEC 的中位 OS 为 23 个月，1、3 和 5 年的 OS 分别为 62%、50%和 39%。
局部食管和胃（MA）NEC 常在内镜活检时被误诊。切除后，分别有 35%和 39%的患者获得长期生存。
