Department of Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Department of Pathology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
Acta Gastroenterol Belg. 2022 Apr-Jun;85(2):339-345. doi: 10.51821/85.2.8601.
Gastric neuroendocrine tumors [gNETs] are heterogeneous tumors and we are still unable to predict the behavior of these tumors. We aim to define the prognostic parameters of well-differentiated gNETs based on metastatic potential and to evaluate the current classification systems.
We retrospectively retrieved 44 well differentiated gNET cases who underwent radical surgery between 2000-2015 at two tertiary-care centers.
Among the 44 well-differentiated gNET patients, 17 (38%) patients had metastatic disease to lymph nodes and/or distant sites, while 27 (62%) were confined to the stomach. Higher risk of metastasis was observed with increasing tumor size, grade, depth of invasion and with type-3 and solitary tumors. 30 (68%) patients had type-1 gNET and 14 (32%) had type-3 gNET. Majority of the type-1 cases (76,6%) were Grade 1 [G1] and type-3 cases (78,5%) were Grade 3 [G3]. Type-1 subgroup had no G3 tumor, and type-3 had no G1. Grade 2 [G2] tumors were more controversial, with metastatic and non-metastatic cases. G2 cases with a >10% Ki67 expression or type-3, had a worse prognosis. Although most of the type-1 gNETs had an indolent course, 6 of 30 (20%) patients had metastatic disease. Metastasizing type-1 gNETs were >10 mm in diameter or extended to/beyond the submucosa.
Regarding our results, tumor type, grade, size, focality and depth of invasion are the prognostic parameters for gNETs, based on metastatic potential. Besides these parameters, a two-tiered grading system with a 10% Ki-67 proliferation index cut-off value could be considered for right treatment choice.
胃神经内分泌肿瘤（gNET）是一种异质性肿瘤，我们仍然无法预测这些肿瘤的行为。我们旨在根据转移潜能定义分化良好的 gNET 的预后参数，并评估当前的分类系统。
我们回顾性地检索了 2000 年至 2015 年间在两个三级护理中心接受根治性手术的 44 例分化良好的 gNET 患者。
在 44 例分化良好的 gNET 患者中，17 例（38%）患者有淋巴结和/或远处转移的转移性疾病，而 27 例（62%）局限于胃。肿瘤大小、分级、浸润深度增加，以及 3 型和单发肿瘤与更高的转移风险相关。30 例（68%）患者为 1 型 gNET，14 例（32%）为 3 型 gNET。大多数 1 型病例（76.6%）为 G1，3 型病例（78.5%）为 G3。1 型亚组无 G3 肿瘤，3 型无 G1 肿瘤。G2 肿瘤存在争议，有转移和非转移病例。Ki67 表达>10%或 3 型的 G2 病例预后较差。虽然大多数 1 型 gNET 表现为惰性病程，但 30 例中有 6 例（20%）发生转移。转移的 1 型 gNET 直径>10mm 或延伸至/超出黏膜下层。
根据我们的结果，肿瘤类型、分级、大小、局灶性和浸润深度是基于转移潜能的 gNET 预后参数。除了这些参数外，还可以考虑使用 Ki-67 增殖指数截断值为 10%的两级分级系统来进行正确的治疗选择。
