Li Y, Wang Y F, Tan B B, Er L M, Zhao Q, Fan L Q, Zhang Z D, Liu Y
Third Department of Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
Department of General Surgery, Hebei General Hospital, Shijiazhuang 050051, China.
Zhonghua Zhong Liu Za Zhi. 2020 May 23;42(5):426-431. doi: 10.3760/cma.j.cn112152-112152-20191011-00663.
Biological behavior, pathological characteristics and prognostic factors of 355 cases with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) were analyzed in this retrospective study. In our study, 355 patients pathologically diagnosed as GEP-NENs were identified from April 2006 to November 2017 in the Fourth Hospital of Hebei Medical University. The biological behavior, pathological characteristics and prognosis were analyzed retrospectively. There were 355 patients (228 males and 127 females) with a mean age of 58.3±10.7 years. GEP-NENs were detected most frequently in the stomach (48.2%), followed by the pancreas (16.1%), colorectum (14.1%), esophagus (7.6%), duodenum/jejunum(5.6%), liver (4.2%), appendix (2.3%) and gallbladder/bile duct (2.0%). The main clinical manifestations of non-functional GEP-NENs were abdominal pain (88/350, 25.14%), ventosity (77/350, 22.00%) and dysphagia (68/350, 19.43%), which were generally lacking specificity at the first diagnosis. 295 patients were treated surgically, including 45 cases of endoscopic resection and 250 cases of laparoscopic operation. Concerning to pathological grading, there were 22.5% (80/355) patients in grade 1 (G1), 12.7% (45/355) in grade 2 (G2), and 58.9% (209/355) in grade 3 (G3). The median follow-up time was 34 months. Furthermore, the 1-, 3- and 5-year overall survival calculated by Kaplan-Meier method were 80.1%, 59.8%, and 57.5%, respectively. Univariate analysis revealed that tumor site, treatment, operation type, depth of tumor invasion, TNM staging, pathological grading, vascular embolus, lymph node metastasis, tumor size, preoperative leukomonocyte level and preoperative plasma albumin were associated with overall survival (all <0.05). Multivariate analysis showed that treatment, operation type, depth of tumor invasion, TNM staging, pathological grading, vascular embolus, lymph node metastasis and tumor size were independent prognostic factors for GEP-NENs (all <0.05). The clinicopathological characteristics of GEP-NENs should be mastered by clinicians, and the standard treatment measures were also needed to be formulated based on the prognostic factors in order to improve the prognosis of patients.
本回顾性研究分析了355例胃肠胰神经内分泌肿瘤（GEP-NENs）患者的生物学行为、病理特征及预后因素。在我们的研究中，2006年4月至2017年11月在河北医科大学第四医院共确定了355例经病理诊断为GEP-NENs的患者。对其生物学行为、病理特征及预后进行了回顾性分析。共有355例患者（男性228例，女性127例），平均年龄58.3±10.7岁。GEP-NENs最常发生于胃（48.2%），其次为胰腺（16.1%）、结直肠（14.1%）、食管（7.6%）、十二指肠/空肠（5.6%）、肝脏（4.2%）、阑尾（2.3%）和胆囊/胆管（2.0%）。无功能GEP-NENs的主要临床表现为腹痛（88/350，25.14%）、腹胀（77/350，22.00%）和吞咽困难（68/350，19.43%），初诊时通常缺乏特异性。295例患者接受了手术治疗，其中内镜切除45例，腹腔镜手术250例。病理分级方面，1级（G1）患者占22.5%（80/355），2级（G2）占12.7%（45/355），3级（G3）占58.9%（209/355）。中位随访时间为34个月。此外，采用Kaplan-Meier法计算的1年、3年和5年总生存率分别为80.1%、59.8%和57.5%。单因素分析显示，肿瘤部位、治疗方式、手术类型、肿瘤浸润深度、TNM分期、病理分级、血管栓塞、淋巴结转移、肿瘤大小、术前白细胞水平和术前血浆白蛋白与总生存率相关（均<0.05）。多因素分析表明，治疗方式、手术类型、肿瘤浸润深度、TNM分期、病理分级、血管栓塞、淋巴结转移和肿瘤大小是GEP-NENs的独立预后因素（均<0.05）。临床医生应掌握GEP-NENs的临床病理特征，并根据预后因素制定规范的治疗措施，以改善患者的预后。
