结直肠神经内分泌癌的临床诊治及预后  

Diagnosis, treatment and prognosis of neuroendocrine carcinoma of the colorectum

作　　者：张勇超[1] 庄兢[1] 韩广森[1] 王金榜[1] 

机构地区：[1]河南省肿瘤医院普通外科,郑州450003

出　　处：《中华胃肠外科杂志》2011年第12期955-957,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨结直肠神经内分泌癌的临床诊治及预后。方法回顾性分析1995年1月至2010年1月间河南省肿瘤医院收治的39例结直肠神经内分泌癌患者的临床资料。结果39例患者中男27例．女12例。所有病例均未出现内分泌紊乱的表现，术前有14例（35．9％）经病理学诊断为神经内分泌癌。22例患者行根治性手术．14例行姑息性切除术，3例仅行活检术。所有病例均予顺铂加依托泊苷的术后辅助化疗。36例切除的病灶中，27例（75．0％）有脉管浸润，29例（80．6％）有淋巴结转移：全组患者中有11例（28．2％）出现远处转移。病理分型：高分化型22例（56．4％），中间型9例（23．1％）．小细胞型8例（20．5％）。全组患者术后获得4．67个月的随访，1、3、5年生存率分别为48．2％、16．5％和6．8％。患者的生存状况与肿瘤的分期、脉管浸润和手术根治性有关（P〈0．05）；而与年龄、性别、肿瘤的大小和位置无关（P〉0．05）。结论结直肠神经内分泌癌无特异性临床表现，恶性程度高．预后差，肿瘤分期、有无脉管浸润和能否根治切除是影响预后的重要因素。Objective To investigate the diagnosis, treatment and prognosis of colorectal neuroendocrine carcinoma. Methods Clinical data of 39 patients with colorectal neuroendocrine carcinoma from Jan 1995 to Jan 2010 were analyzed retrospectively and the related literatures were reviewed. Results There were 27 males and 12 females. No patients presented endocrinal dysfunction symptoms. Fourteen patients were diagnosed as neuroendocrine cancer by preoperative pathological examination. All the patients received postoperative adjuvant chemotherapy including cis-platinum and etoposide. Twenty-two patients underwent curative resection, while 14 underwent palliative resection and 3 underwent biopsy alone. Of the 36 surgical resection specimens, vascular invasion was found in 27 patients （75.0%） and regional lymph node metastasis was found in 29 patients （80.6%）. Length of follow-up ranged from 4 to 67 months. The 1-year, 3-year and 5-year survival rates were 48.2%, 16.5% and 6.8%, respectively. Statistically significant differences in survival were observed and associated with tumor staging, vascular invasion and surgery type （P〈0.05）, but not related to gender, age, tumor location, or diameter （P〉0.05）. Conclusions Clinical symptoms and signs of colorectal neuroendocrine carcinoma are nonspeeifie with poor prognosis. Tumor staging, vascular invasion and surgical type have potential impact on survival.

关 键 词：结直肠肿瘤 神经内分泌癌 诊断 治疗 预后 

分 类 号：R735.3[医药卫生—肿瘤]