Zhou Kai, Li Zhong-Wu, Wu Yan, Wang Zhi-Jie, Wang Ling-Qian, Zhou Li-Xin, Jia Ling, Ji Ke, Yang Xue-Song, Zhang Ji, Wu Xiao-Jiang, Wang An-Qiang, Bu Zhao-De
Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
World J Gastroenterol. 2025 Feb 28;31(8):102347. doi: 10.3748/wjg.v31.i8.102347.
Gastric mixed-adenoneuroendocrine carcinoma (G-MANEC) is a subtype of gastric cancer. Building upon prior research findings, we propose that tumours containing both neuroendocrine carcinoma (NEC) and adenocarcinoma (AC) components, with each component ranging from 1% to 99% of the tumour, be classified as a distinct entity. We hereby term this adenoneuroendocrine mixed gastric cancer (G-ANEC). Research on lymph node (LN) involvement in G-MANEC has focused mainly on metastasis status, with limited studies on metastatic composition.
To investigate the LN metastasis patterns of G-ANEC, the clinicopathological features associated with these metastasis patterns, and to explore adjuvant chemotherapy regimens for G-ANEC.
We analyzed 68 G-ANEC cases treated with radical surgery and confirmed LN metastasis at Peking University Cancer Hospital between August 2012 and June 2022. Utilizing tests in IBM statistical product and service solutions statistics and R software.
We identified three distinct LN metastasis patterns in G-ANEC that were significantly associated with the NEC proportion, tumour invasion depth, Lauren classification, and tumour location ( values: 0.008, 0.015, 0.01, and 0.004, respectively). When the SOX/XELOX regimen was applied for adjuvant chemotherapy, patients with LN metastasis comprising only AC exhibited better overall survival (OS) (94.25 ± 11.07 months 54.36 ± 11.36 months) than did those with NEC. When LN metastasis components contained NEC, there was a trend towards improved OS (64 ± 10.77 months 54.35 ± 11.36 months) and disease-free survival (71.28 ± 9.92 months 66.28 ± 11.93 months) in patients treated with the etoposide and cisplatin compared to those receiving the SOX/XELOX regimen.
We found a significant correlation between the NEC percentage, tumour invasion depth, Lauren classification, and tumour location and LN metastasis patterns in G-ANEC. For G-ANEC, a lower proportion of NEC or AC in the primary lesion does not preclude the possibility of these components metastasizing to the LNs. Different adjuvant chemotherapy regimens should be administered on the basis of the varying components of LN metastasis in patients with G-ANEC.
胃混合性腺神经内分泌癌（G-MANEC）是胃癌的一种亚型。基于先前的研究结果，我们提出，肿瘤同时包含神经内分泌癌（NEC）和腺癌（AC）成分，且每种成分占肿瘤的比例在1%至99%之间的，应归类为一种独特的实体。我们特此将其命名为腺神经内分泌混合性胃癌（G-ANEC）。关于G-MANEC淋巴结（LN）受累情况的研究主要集中在转移状态，而对转移成分的研究有限。
研究G-ANEC的LN转移模式、与这些转移模式相关的临床病理特征，并探索G-ANEC的辅助化疗方案。
我们分析了2012年8月至2022年6月期间在北京大学肿瘤医院接受根治性手术且确诊有LN转移的68例G-ANEC病例。使用IBM统计产品与服务解决方案统计软件和R软件进行检验。
我们在G-ANEC中确定了三种不同的LN转移模式，它们与NEC比例、肿瘤浸润深度、劳伦分类和肿瘤位置显著相关（P值分别为：0.008、0.015、0.01和0.004）。当应用SOX/XELOX方案进行辅助化疗时，LN转移仅包含AC的患者总生存期（OS）更好（94.25±11.07个月对54.36±11.36个月），优于LN转移包含NEC的患者。当LN转移成分包含NEC时，与接受SOX/XELOX方案的患者相比，接受依托泊苷和顺铂治疗的患者有OS改善趋势（64±10.77个月对54.35±11.36个月）和无病生存期改善趋势（71.28±9.92个月对66.28±11.93个月）。
我们发现G-ANEC中NEC百分比、肿瘤浸润深度、劳伦分类和肿瘤位置与LN转移模式之间存在显著相关性。对于G-ANEC，原发灶中NEC或AC比例较低并不排除这些成分转移至LN的可能性。应根据G-ANEC患者LN转移的不同成分给予不同的辅助化疗方案。
