Xiong Y J, Liu X Y, Cheng C E, Chen C, Sun Y B, Tan C H, Liu Y T, Feng J, Ma Y F, Shi D T, Li R, Tang Q Y
Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Department of Gastroenterology, Yulin No.2 Hospital, Yulin, Shaanxi Province 719000, China.
Zhonghua Nei Ke Za Zhi. 2020 Apr 1;59(4):297-302. doi: 10.3760/cma.j.cn112138-20190705-00474.
To study the clinical characteristics and classification of gastric neuroendocrine neoplasm(NEN) and prognostic factors of mixed adenoneuroendocrine carcinoma (MANEC) and gastric neuroendocrine carcinoma(NEC). A total of 148 gastric NENs were divided into type Ⅰ, type Ⅱ and type Ⅲ based on the classification of European Neuroendocrine Tumor Society (ENETS). Kaplan-Meier test and Cox regression model were used in univariate and multivariate survival analysis in 108 cases with pathological G3 gastric NEN. In this study, the percentages of type Ⅰ, type Ⅱ and type Ⅲ were 25.0%(37), 3.4%(5) and 71.6%(106) respectively. Among type Ⅰ patients, 28(75.7%) lesions were located in gastric fundus or body, 29(78.4%) had bumps. Lymph node involvement was found in 4 (10.8%) patients. Twenty-six (70.3%) patients received endoscopic treatment and 11 (29.7%) with surgery. All 5 type Ⅱ patients presented lesions in gastric fundus or body, including 4 with ulcers, who were all treated by endoscope. Three type Ⅱ patients had gastrinoma, and 2 combined with multiple endocrine neoplasmⅠ. In type Ⅲ patients, 56(52.8%) showed ulcerative lesions. The majority of patients (102, 96.2%) had a single lesion, 94(88.7%) with lymph node or other organ metastasis. In this study, no deaths were reported in gastric NEN with a pathological grade of G1 or G2. The mortality rate was 38.9%(42/108) in patients with G3 NEN. Survival analysis suggested that age, metastasis of tumor were associated with poor prognosis (=0.041, 0.025). Patients with gastric NEN have heterogenous clinical presentations according to gender, age, endoscopic features, infiltration and metastasis, and pathological grade. Aging and metastasis are negative prognostic factors of G3 gastric NEN.
研究胃神经内分泌肿瘤（NEN）的临床特征、分类以及混合性腺神经内分泌癌（MANEC）和胃神经内分泌癌（NEC）的预后因素。根据欧洲神经内分泌肿瘤学会（ENETS）的分类，将148例胃NEN分为Ⅰ型、Ⅱ型和Ⅲ型。对108例病理G3级胃NEN患者进行单因素和多因素生存分析，采用Kaplan-Meier检验和Cox回归模型。本研究中，Ⅰ型、Ⅱ型和Ⅲ型的比例分别为25.0%（37例）、3.4%（5例）和71.6%（106例）。Ⅰ型患者中，28例（75.7%）病变位于胃底或胃体，29例（78.4%）有隆起。4例（10.8%）患者有淋巴结转移。26例（70.3%）患者接受内镜治疗，11例（29.7%）接受手术治疗。所有5例Ⅱ型患者病变均位于胃底或胃体，其中4例有溃疡，均接受内镜治疗。3例Ⅱ型患者有胃泌素瘤，2例合并多发性内分泌肿瘤Ⅰ型。Ⅲ型患者中，56例（52.8%）表现为溃疡性病变。大多数患者（102例，96.2%）为单发病变，94例（88.7%）有淋巴结或其他器官转移。本研究中，病理G1或G2级胃NEN无死亡报告。G3级NEN患者的死亡率为38.9%（42/108）。生存分析表明，年龄、肿瘤转移与预后不良相关（P = 0.041，0.025）。胃NEN患者根据性别、年龄、内镜特征、浸润和转移情况以及病理分级具有不同的临床表现。年龄增长和转移是G3级胃NEN的不良预后因素。
