摘要
目的探讨发病率极低的胃混合性腺神经内分泌癌(G-MANEC)早期临床病理特征及其预后影响因素,为临床诊治提供参考。方法采用回顾性观察性研究方法。收集2014年7月至2022年5月期间,复旦大学附属中山医院通过手术切除并经病理确诊的36例早期G-MANEC患者的病历资料。观察指标包括临床病理资料和随访情况[复发转移和总体生存(OS)情况]。结果本组36例早期G-MANEC患者中,男性21例,女性15例,年龄32~84(65±11)岁。首发症状以腹痛或腹胀为主者19例(52.8%),7例(19.4%)为体检发现。肿瘤位于近端胃13例(36.1%),中段胃4例(11.1%),远端胃19例(52.8%)。肿瘤长径为(2.48±1.18)cm。肿瘤大体形态为隆起型12例(33.3%),平坦型20例(55.6%)和凹陷型4例(11.1%)。有溃疡12例(33.3%)。T1a期11例(30.6%),T1b期25例(69.4%)。10例(27.8%)淋巴结转移阳性。腺癌分化程度高、中、低者分别有3例(8.3%)、10例(27.8%)和23例(63.9%)。神经内分泌癌占比≥50%和<50%各有18例(50.0%)。脉管或神经束侵犯有18例(50.0%)。肿瘤Lauren分型混合型、肠型、弥漫型分别有10例(27.8%)、19例(52.8%)和7例(19.4%)。嗜铬粒蛋白A阳性20例(55.6%)。Ki-67指数≥20%有26例(72.2%)。12例(33.3%)接受全胃切除,24例(66.7%)接受部分胃切除。全组患者中位随访77.5个月,3年及5年总体生存率分别为88.89%和79.67%。单因素分析显示,年龄、大体形态、溃疡形成、神经内分泌癌成分占比、脉管或神经束侵犯及嗜铬粒蛋白A阳性与本组患者OS有关(均P<0.10)。影响预后的多因素分析显示,合并溃疡(HR=7.74,95%CI:1.24~48.30,P=0.028)和嗜铬粒蛋白A阳性(HR=21.76,95%CI:1.86~53.97,P=0.014)为影响本组患者OS的独立危险因素。结论早期G-MANEC症状隐匿;伴有溃疡和嗜铬粒蛋白A免疫组化阳性的患者预后不佳。
Objective This study analyzes the clinicopathological features and prognostic factors of early-stage gastric mixed adenoneuroendocrine carcinoma(G-MANEC),which is an exceedingly rare malignancy,in an effort to provide evidence-based insights for clinical decision-making.Methods A retrospective observational study was conducted using the clinical data of 36 patients with early-stage G-MANEC who underwent surgical resection at Zhongshan Hospital,Fudan University,from July 2014 to May 2022.The observed indicators included clinicopathological data and follow-up information on recurrence,metastasis,and overall survival(OS).Results Among the 36 patients there were 21 males and 15 females,aged 32-84(65±11)years.The most common initial symptoms were abdominal pain and distension(19/36,52.8%),followed by incidental findings during physical examinations(7/36,19.4%).Tumors were located in the proximal stomach in 13 cases(36.1%),the middle stomach in 4 cases(11.1%),and the distal stomach in 19 cases(52.8%).Average tumor diameter was(2.48±1.18)cm.Gross morphology included elevated type in 12 cases(33.3%),flat type in 20 cases(55.6%),and depressed type in 4 cases(11.1%).Ulceration was present in 12 cases(33.3%).There were 11 cases(30.6%)at T1a stage and 25 cases(69.4%)at T1b stage.Lymph node metastasis was positive in 10 cases(27.8%),and the differentiation grades of the adenocarcinoma component were Grade I,II,and III in 3(8.3%),10(27.8%),and 23(63.9%)cases,respectively.Furthermore,the proportion of neuroendocrine carcinoma component was≥50%in 18 cases(50.0%)and<50%in 18 cases(50.0%).Lymphovascular or perineural invasion was present in 18 cases(50.0%).Lauren classification included mixed type in 10 cases(27.8%),intestinal type in 19 cases(52.8%),and diffuse type in 7 cases(19.4%),and chromogranin A(CgA)positivity was found in 20 cases(55.6%).Additionally,the Ki-67 index positivity was found in 26 cases(72.2%).Total gastrectomy was performed in 12 cases(33.3%)and partial gastrectomy in 24 cases(66.7%),with a median follow-up duration of 77.5 months.The 3-year and 5-year OS rates were 88.89%and 79.67%,respectively.Univariate analysis revealed that age,gross morphology,ulceration,proportion of neuroendocrine carcinoma component,lymphovascular or perineural invasion,and chromogranin A(CgA)positivity showed statistical significance in their association with OS(P<0.10).Multivariate Cox regression analysis further identified ulceration(HR=7.74,95%CI:1.24-48.30,P=0.028)and CgA positivity(HR=21.76,95%CI:1.86-53.97,P=0.014)as independent risk factors of OS.Conclusion sPatients with early-stage G-MANEC are typically asymptomatic,and those with ulceration or positive CgA immunohistochemical staining tend to have a poor prognosis.
作者
熊冉
孙祥飞
袁伟
周瑜凝
孙胤文
姜文超
王洪山
汪学非
高晓东
Xiong Ran;Sun Xiangfei;Yuan Wei;Zhou Yuning;Sun Yinwen;Jiang Wenchao;Wang Hongshan;Wang Xuefei;Gao Xiaodong(Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华胃肠外科杂志》
北大核心
2025年第10期1151-1155,共5页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金(82173161,82473124)。
关键词
胃混合性腺神经内分泌癌
早期
临床病理特征
预后因素
Gastric mixed adenoneuroendocrine carcinoma,early
Clinicopathological characteristics
Prognostic factors
