消化系统神经内分泌肿瘤的临床病理特征与生存分析

摘要

Objective:To explore the clinicopathological characteristics and prognostic factors of neuroendocrine neoplasms(NENs)at different sites in the digestive system.Methods:The clinicopathological parameters and follow-up data were collected from 284 pa-tients with NENs in the digestive system in Tianjin Medical University Cancer Institute and Hospital from March 2011 to December 2015.The incidence and clinicopathological features were compared between the cases of NENs at different sites and survival analysis was performed.Results:In this study,NENs were detected mostly frequently in the pancreas,followed by the colorectum and stom-ach.In the pancreas,neuroendocrine tumor(NET)G1(51.8%)and G2(35.8%)accounted for a large proportion of NENs.World Health Organization(WHO)grades were related to lymph node metastasis,adjacent organ invasion,and nerve invasion(P<0.05 for all)but were not associated with the overall survival time of the patients.The patients with pancreatic NENs with distant metastasis had poor overall survival(P<0.05).Regarding colorectal NENs,most patients had NET G1(82.5%),and the majority of patients were cured with endoscopic or transanal resection.Patients with NENs,lymph node metastasis,and distant metastasis had poor overall survival(P<0.05 for all).The ratio of male-to-female patients,proportion of patients aged older than 40 years,prevalence of neuroendocrine carci-nomas(NECs)and mixed adenoneuroendocrine carcinomas(MANECs),presence of lymph node and distant metastasis,and presence of advanced stage tumors were greater in patients with gastric NENs than in patients with pancreatic and colorectal NENs(P<0.05 for all).WHO grades and lymph node metastasis were associated with the overall survival time of patients with gastric NENs(P<0.05 for both).Conclusions:NENs in the digestive system are a group of heterogeneous tumors with different clinicopathological features at different sites.The distribution and clinicopathological features of Chinese patients with NENs in the digestive system are different from those of European and American patients.More multicenter studies with large sample sizes are still needed to understand the bi-ological behaviors and prognostic factors of NENs at different sites in the digestive system.%目的:探讨消化系统不同部位神经内分泌肿瘤(neuroendocrine neoplasms,NENs)的临床病理特征及预后因素.方法:收集天津医科大学肿瘤医院2011年3月至2015年12月收治的284例消化系统NENs,分析比较不同部位NENs临床病理特征的异同,并进行生存分析.结果:本研究中,消化系统NENs以胰腺部位最多见,其次为结直肠、胃.在胰腺NENs中,以G1(51.8%)和G2 (35.8%)型为主,WHO分类与淋巴结转移、周围器官侵犯、神经侵犯有关(均P<0.05),但与患者的总生存无关;有远处转移的胰腺NENs患者总生存期更短(P<0.05).结直肠NENs以NET G1为主(82.5%),大多经内镜下切除或经肛门直肠肿物切除;神经内分泌癌、有淋巴结转移、有远处转移和进展期患者的总生存期更短(均P<0.05).与胰腺和结直肠相比,胃NENs中男性患者、年龄>40岁的患者更多;神经内分泌癌和混合性腺神经内分泌癌比例更高、淋巴结转移和远处转移的比例更高;进展期的患者更多(均P<0.05).WHO分类和有无淋巴结转移与胃NENs的总生存期有关(均P<0.05).结论:消化系统NENs是一组异质性肿瘤,不同部位的肿瘤具有不同的临床病理特征,并与欧美国家存在差异.仍需要大样本多中心研究来了解不同部位消化系统NENs的生物学行为及预后因素.