Namikawa Ken, Kamada Tomoari, Fujisaki Junko, Sato Yuichi, Murao Takahisa, Chiba Tsutomu, Kaizaki Yasuharu, Ishido Kenji, Ihara Yutaro, Kurahara Koichi, Suga Tomoaki, Suzuki Haruhisa, Ito Masanori, Hirakawa Katsuya, Maruyama Yasuhiko, Gotoda Takuji, Hosokawa Osamu, Koike Tomohiro, Mabe Katsuhiro, Yao Takashi, Inui Kazuo, Iishi Hiroyasu, Ogata Haruhiko, Furuta Takahisa, Haruma Ken
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Research Group on the Treatment Guidelines for Gastric Carcinoids Associated with Autoimmune Gastritis in Japan, Tokyo, Japan.
Dig Endosc. 2023 Sep;35(6):757-766. doi: 10.1111/den.14529. Epub 2023 Mar 28.
Optimal management of type 1 gastric neuroendocrine tumors (T1-GNETs) remains unknown, with few reports on their long-term prognosis. This study investigated the clinical characteristics and long-term prognosis of T1-GNETs.
We reviewed the medical records of patients diagnosed with T1-GNET during 1991-2019 at 40 institutions in Japan.
Among 172 patients, endoscopic resection (ER), endoscopic surveillance, and surgery were performed in 84, 61, and 27, respectively, including 27, 77, and 2 patients with pT1a-M, pT1b-SM, and pT2 tumors, respectively. The median tumor diameter was 5 (range 0.8-55) mm. Four (2.9%) patients had lymph node metastasis (LNM); none had liver metastasis. LNM rates were significantly higher in tumors with lymphovascular invasion (LVI) (15.8%; 3/19) than in those without (1.1%; 1/92) (P = 0.016). For tumors <10 mm, LVI and LNM rates were 18.4% (14/76) and 2.2% (2/90), respectively, which were not significantly different from those of tumors 10-20 mm (LVI 13.3%; 2/15, P = 0.211; and LNM 0%; 0/17, P = 1.0). However, these rates were significantly lower than those of tumors >20 mm (LVI 60%; 3/5, P = 0.021; and LNM 40%; 2/5, P = 0.039). No tumor recurrence or cause-specific death occurred during the median follow-up of 10.1 (1-25) years. The 10-year overall survival rate was 97%.
Type 1 gastric neuroendocrine tumors showed indolent nature and favorable long-term prognoses. LVI could be useful in indicating the need for additional treatments. ER for risk prediction of LNM should be considered for tumors <10 mm and may be feasible for tumors 10-20 mm.
The study protocol was registered in the University Hospital Medical Information Network (UMIN) under the identifier UMIN000029927.
1型胃神经内分泌肿瘤（T1-GNETs）的最佳管理尚不清楚，关于其长期预后的报道很少。本研究调查了T1-GNETs的临床特征和长期预后。
我们回顾了1991年至2019年期间日本40家机构诊断为T1-GNETs的患者的病历。
172例患者中，分别有84例、61例和27例接受了内镜切除（ER）、内镜监测和手术，其中分别有27例、77例和2例患者的肿瘤为pT1a-M、pT1b-SM和pT2。肿瘤中位直径为5（范围0.8-55）mm。4例（2.9%）患者有淋巴结转移（LNM）；无肝转移。有脉管侵犯（LVI）的肿瘤的LNM率（15.8%；3/19）显著高于无LVI的肿瘤（1.1%；1/92）（P = 0.016）。对于直径<10 mm的肿瘤，LVI和LNM率分别为18.4%（14/76）和2.2%（2/90），与直径10-20 mm的肿瘤无显著差异（LVI 13.3%；2/15，P = 0.211；LNM 0%；0/17，P = 1.0）。然而，这些比率显著低于直径>20 mm的肿瘤（LVI 60%；3/5，P = 0.021；LNM 40%；2/5，P = 0.039）。在中位随访10.1（1-25）年期间，无肿瘤复发或因肿瘤导致的死亡发生。10年总生存率为97%。
1型胃神经内分泌肿瘤表现出惰性特征和良好的长期预后。LVI可能有助于指示是否需要额外治疗。对于直径<10 mm的肿瘤，应考虑行ER以预测LNM风险，对于直径10-20 mm的肿瘤可能可行。
本研究方案已在大学医院医学信息网络（UMIN）注册，标识符为UMIN000029927。
