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胃肠胰神经内分泌肿瘤患者的预后因素。

Prognostic factors of patients with gastroenteropancreatic neuroendocrine neoplasms.

机构信息

Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Division of Colon and Rectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

出版信息

Kaohsiung J Med Sci. 2018 Nov;34(11):650-656. doi: 10.1016/j.kjms.2018.05.009. Epub 2018 Jun 20.

Abstract

There is an increasing trend in the incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) worldwide. The aim of the present study was to identify the prognostic factors of patients with GEP-NENs. A cross-sectional, retrospective chart review study was conducted among patients with pathologically proven GEP-NENs between January 2003 and December 2016 at Kaohsiung Chung-Gung Memorial Hospital. A total of 97 patients who met the inclusion criteria were included (male/female = 56/41, age: 57.7 ± 15.4 years). The presentation, clinical characteristics, and disease outcomes were reviewed and analyzed. The most common primary site of the GEP-NENs was the rectum (49.5%), followed by the pancreas (17.5%), duodenum (11.3%), stomach (10.3%), colon (6.2%), and appendix (5.2%), and most GEP-NENs were hormonally nonfunctional (94.8%). There were 56 tumors classified as G1 neuroendocrine tumors (NETs), 9 as G2 NETs, and 14 as G3 neuroendocrine carcinoma (NEC). Metastasis was found in 15 patients (15%). Curative treatments, such as surgery or endoscopic resection, were performed in 83.5% of patients (n = 81). The mean overall survival duration was 107.2 ± 7.8 months. The estimated 3- and 5-year overall survival rates for all patients were 84% and 82%, respectively. Logistic regression analysis showed that large tumor size, non-rectal NENs, high histopathological grading, lymphatic metastases and distant metastases were associated with poor survival. This study suggested that the presence of lymphatic or distant metastases at diagnosis is an independent risk factor for poor prognosis in patients with GEP-NENs.

摘要

全球范围内,胃肠道胰神经内分泌肿瘤(GEP-NENs)的发病率呈上升趋势。本研究旨在确定 GEP-NENs 患者的预后因素。一项回顾性横断面研究,纳入了 2003 年 1 月至 2016 年 12 月在高雄长庚纪念医院经病理证实的 GEP-NENs 患者。共纳入符合纳入标准的 97 例患者(男/女=56/41,年龄:57.7±15.4 岁)。回顾和分析了这些患者的表现、临床特征和疾病结局。GEP-NENs 最常见的原发部位是直肠(49.5%),其次是胰腺(17.5%)、十二指肠(11.3%)、胃(10.3%)、结肠(6.2%)和阑尾(5.2%),大多数 GEP-NENs 无激素功能(94.8%)。其中 56 例肿瘤为 G1 神经内分泌肿瘤(NETs),9 例为 G2 NETs,14 例为 G3 神经内分泌癌(NEC)。15 例患者(15%)发现转移。83.5%(n=81)的患者接受了根治性治疗,如手术或内镜下切除。患者的平均总生存时间为 107.2±7.8 个月。所有患者的 3 年和 5 年总生存率分别为 84%和 82%。Logistic 回归分析显示,肿瘤体积大、非直肠 NENs、高组织学分级、淋巴转移和远处转移与生存不良相关。本研究表明,诊断时存在淋巴或远处转移是 GEP-NENs 患者预后不良的独立危险因素。

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