胃肠胰神经内分泌肿瘤的最新分类系统：单中心经验。
Recent classifications systems for gastroenteropancreatic neuroendocrine tumors A single-center experience.
出版信息
Ann Ital Chir. 2020;91:598-604.
AIM
In this study, we aimed to review the demographic histopathological and clinical findings and long-term results of our GEP-NET cases, as well as to re-evaluate our cases according to the new classification systems.
MATERIAL AND METHOD
46 patients diagnosed as GEPNETs were presented. Immunohistochemical studies were performed in all cases. The cases were divided into 3 groups according to their embryogenic origin (Foregut, Midgut and Hindgut). All cases re-evaluated according to recent WHO (2019) and AJCC (2017) TNM calcification. Investigation was made to find differences between the embryonic origins and to find correlation between stage and grading systems with each other.
RESULTS
The most common localization was appendix (52.3%) The distribution of cases according to embryologic origin were as follows: foregut tumors 13 cases (27.7%), midgut tumors 27 cases (57.4%) and hindgut tumors in 6 cases (12.8%). The Ki-67 ratio was evaluated in all patients, with a mean of 6.34%±2.51 (range: 1-80). The Ki-67 ratio was less than 3% in 82.6% of patients. Mitotic count was less than 2 per/10 HPF in 76% of patients. According to WHO 2019 most of patients were Grade 1 Neuroendocrine Tumor (65.2%) and there were only 2 Neuroendocrine Carcinoma (NEC) cases. According to AJCC 2017 most cases were Stage 1 (52.1%) and only 4 cases were Stage 4. The grades and stages of our cases were statistically significantly correlated. Overall survival did not differ significantly with regard to embryologic origin (log-rank test, p=0.062). The median overall survival was 106±7.4 months. The 5-year cumulative survival rate was 84.1±5.6 years. Seven patients died during this time with a median time of 5 months (range: 1-31 months). In the Cox regression analysis, the percentage of Ki- 67 was found to have a statistically significant effect on overall survival (p=0.000) CONCLUSION: Correlation was noticed between WHO 2019 and AJCC 2017 classification for grade and stage and controlled trials must be undertaken to develop a single diagnostic algorithm and to change the future management of such patients.
KEY WORDS
Neuroendocrine Tumors, Gastroenteropancreatic neuroendocrine tumor.
目的
本研究旨在回顾我们的胃泌素瘤神经内分泌肿瘤（GEP-NET）病例的人口统计学、组织病理学和临床发现以及长期结果，并根据新的分类系统重新评估我们的病例。
材料和方法
呈现了 46 例诊断为 GEP-NETs 的患者。所有病例均行免疫组织化学研究。根据胚胎起源（前肠、中肠和后肠）将病例分为 3 组。根据最近的世界卫生组织（2019 年）和美国癌症联合委员会（2017 年）TNM 钙化标准，对所有病例进行重新评估。研究了胚胎起源之间的差异，并研究了分级和分期系统之间的相关性。
结果
最常见的定位是阑尾（52.3%）。根据胚胎起源，病例分布如下：前肠肿瘤 13 例（27.7%），中肠肿瘤 27 例（57.4%），后肠肿瘤 6 例（12.8%）。所有患者均评估了 Ki-67 比值，平均值为 6.34%±2.51（范围：1-80）。Ki-67 比值<3%的患者占 82.6%。有丝分裂计数<2/10 HPF 的患者占 76%。根据 2019 年世界卫生组织标准，大多数患者为 1 级神经内分泌肿瘤（65.2%），仅有 2 例神经内分泌癌（NEC）病例。根据 2017 年美国癌症联合委员会标准，大多数病例为 1 期（52.1%），仅有 4 例为 4 期。我们病例的分级和分期呈统计学显著相关。胚胎起源对总生存率无显著影响（对数秩检验，p=0.062）。中位总生存期为 106±7.4 个月。5 年累积生存率为 84.1±5.6 年。在此期间，7 名患者死亡，中位时间为 5 个月（范围：1-31 个月）。在 Cox 回归分析中，Ki-67 百分比被发现对总生存率有统计学显著影响（p=0.000）。
结论
注意到 2019 年世界卫生组织和 2017 年美国癌症联合委员会分级和分期之间的相关性，必须进行对照试验，以制定单一的诊断算法，并改变此类患者的未来管理。
关键词
神经内分泌肿瘤，胃泌素瘤神经内分泌肿瘤。
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