摘要
目的:探讨胃神经内分泌肿瘤临床病理特点及其预后。方法:回顾性分析近11年收治的52例胃神经内分泌肿瘤的临床及病理资料。结果:全组男39例,女13例,平均年龄59岁。根据WHO(2010)神经内分泌肿瘤新分类标准,其中神经内分泌瘤(NET)19例(1级12例,2级7例),神经内分泌癌(NEC)29例,混合性腺神经内分泌癌(MANEC)4例。病变发生于贲门、胃底31例(59.6%),胃体11例(21.2%),胃窦10例(19.2%)。主要临床表现为上腹饱胀不适和吞咽困难。50例接受手术治疗,其中NET患者经内镜切除5例,胃壁局部切除3例,根治性胃切除11例,术后病理显示14例(73.7%)肿瘤局限在黏膜及黏膜下层,淋巴结转移4例(21.1%),脉管瘤栓1例(5.3%);NEC及MANEC患者行开放式根治性手术17例,姑息性手术13例,单纯探查手术1例,术后病理显示29例(96.7%)肿瘤侵及或穿透浆膜,淋巴结转移27例(90%),脉管瘤栓16例(53.3%)。随访2～106个月,19例NET术后局部复发2例(10.5%),远处转移3例(15.8%),死亡2例(10.5%),1,3,5年生存率分别为100%,89%和82%;29例NEC术后局部复发1例(3.4%),远处转移25例(86.2%),死亡21例(72.4%),1,3,5年生存率分别为69%,43%和21%;4例MANEC术后远处转移3例,死亡3例。结论:不同分类的胃神经内分泌肿瘤的临床病理特点及预后各有不同,NET多为早期病变,治疗效果较好;NEC及MANEC恶性程度高,侵袭性强,预后较差。
Objective： To analyze the clinicopathological characteristics and outcomes of gastric neuroendocrine neoplasms. Methods： The clinical and pathological data of 52 patients with gastric neuroendocrine neoplasms admitted to our hospital in recent 11 years were retrospectively analyzed. Results： There were 38 males and 12 females in the whole group, with average age of 54 years. According tothe new WHO classification （2010） of neuroendocrine neoplasms, there were 19 cases of neuroendocrine tumor （NET） （12 cases of G 1 and 7 cases of G2）, 29 cases of neuroendocrine carcinoma （NEC） and 4 cases of mixed adenoneuroendocrine carcinoma （MANEC）. The lesions of the patients were located on the cardia/ fundus （n=31, 59.6%）, corpus （n=1 1, 21.2%） and antrum （n=10, 19.2%） of the stomach, respectively. The main clinical manifestations were epigastric distension/discomfort and dysphagia. Fifty patients underwent surgical treatment. Among the NET patients, 5 cases underwent endoscopic excision, 3 cases underwent local full-thickness excision of the gastric wall and 11 cases underwent radical gastrectomy, and the postoperative pathology demonstrated that the lesions of 14 cases were confined to the mucosal or submucosal layer （73.7%）, 4 cases had lymph node metastases （21.1%） and intravascular tumor thrombus occurred in 1 case （5.3%）. Among the NEC and MANEC patients, 17 cases underwent open radical gastrectom）513 cases underwent palliative surgical treatment and 1 case had a surgical exploration only, and the postoperative pathology showed that the lesions of 29 cases infiltrated or penetrated the serosal layer （96.7%）, 27 cases had lymph node metastases （90%） and intravascular tumor thrombi were found in 16 cases （53.3%）. The follow-up period ranged from 2 to 106 months. Of the 19 NET patients, 2 cases had local recurrence （10.5%）, 3 cases had distant metastases （5.8%） and 2 cases died （10.5%）, and the 1, 3, 5-year survival rate was 100%, 89% and 82%, respectively; of the 29 NEC patients, 1 case had local recurrence （3.4%）, 25 cases had distant metastases （86.2%） and 21 cases died （72.4%）, and the 1, 3, 5-year survival rate was 69%, 43% and 21%, respectively; of the 4 MANEC patients, distant metastases occurred in 3 cases and 3 cases died. Conclusion： The clinicopathological characteristics and prognosis of gastric neuroendocrine neoplasms vary considerably among different types. Most NETs are of early stage disease and have favorable therapeutic efficac）. However, NECs and MANECs are of a high degree of malignancy and invasiveness, and have a poor prognosis.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2012年第6期704-708,共5页
China Journal of General Surgery
关键词
胃肿瘤/外科学
癌
神经内分泌
预后
Stomach Neoplasms/surg
Carcinoma, Neuroendocrine
Prognosis
