116例消化道类癌临床病理和预后分析  

Clinicopathological Characteristics and Prognosis of Gastrointestinal Carcinoids: Analysis of 116 Cases

作　　者：杨浩[1] 朱良如[1] 夏冰[2] 谭诗云[3] 李钢琴 郑丽端[5] 侯晓华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院消化科,430022 [2]武汉大学中南医院消化科 [3]武汉大学人民医院消化科 [4]武汉市第八医院消化科 [5]华中科技大学同济医学院附属协和医院病理科,430022

出　　处：《胃肠病学》2015年第11期658-662,共5页Chinese Journal of Gastroenterology

摘　　要：背景:消化道类癌早期缺乏特异性症状,临床上易被忽视。目的:分析消化道类癌病例的临床病理资料以及治疗和预后情况,以期加强对该病的认识。方法:收集武汉市8家医院1997年1月—2010年1月经病理检查确诊的消化道类癌病例116例,采集性别、年龄、主要症状、诊治经过、肿瘤病理特征、预后等信息进行总结分析。结果:本组消化道类癌最多见于直肠(59.5%)和胃(19.8%),最常见的症状是腹痛、腹胀和便血。免疫组化指标:NSE(+)92.7%,Syn(+)87.5%,Cg A(+)62.5%。胃类癌直径>2 cm者所占比率显著高于直肠类癌(73.9%对13.0%,P<0.001),且多侵及浆膜和浆膜外(81.8%),淋巴结转移率较高(72.7%对17.1%,P<0.001),典型类癌所占比率较低(60.9%对95.7%,P<0.001)。胃类癌和直肠类癌均以手术治疗为主,胃类癌内镜治疗率低于直肠类癌(4.3%对34.8%,P=0.003)。直肠类癌3年(92.8%对62.6%)、5年生存率(62.3%对49.2%)均高于胃类癌,但组间差异无统计学意义(P>0.05)。结论:本组消化道类癌以直肠类癌和胃类癌最为多见。与直肠类癌相比,胃类癌分期较晚,预后较差。患者定期体检,临床医师加强对类癌的认识,掌握不同部位类癌的特点,有助于尽早确诊,规范治疗,以提高患者生存率。Background： Gastrointestinal carcinoids are prone to be neglected in clinical practice because of the poor specific symptoms in early stage. Aims： To analyze the clinicopathological characteristics,treatment modalities and prognosis of a series of cases of gastrointestinal carcinoids for strengthening the understanding of the disease. Methods： A total of 116 patients diagnosed as gastrointestinal carcinoids by pathology from Jan. 1997 to Jan. 2010 in 8 hospitals at Wuhan were enrolled in this retrospective study. Data on sex,age,major symptoms,diagnostic approaches,treatment modalities,pathological features and prognosis, etc. were collected and analyzed. Results： The most common sites of the gastrointestinal carcinoids were rectum（ 59. 5%） and stomach（ 19. 8%）; the most common symptoms were abdominal pain,abdominal distention and hematochezia. The positivity rates of immunohistochemical marker NSE,Syn and CgA were92. 7%,87. 5% and 62. 5%,respectively. The proportion of stomach carcinoids with diameter larger than 2 cm was 73. 9%,and that of rectal carcinoids was only 13. 0%（ P〈0. 001）. Most of the gastric carcinoids（ 81. 8%） infiltrated into or breakthrough the serosa; the rate of lymph node involvement in gastric carcinoids was significantly higher than that in rectal carcinoids（ 72. 7% vs. 17. 1%,P〈0. 001）,while typical carcinoids were less common in stomach than in rectum（ 60. 9%vs. 95. 7%,P〈0. 001）. Only one（ 4. 3%） gastric carcinoid patient underwent endoscopic therapy,while that for rectal carcinoids was 24 cases（ 34. 8%,P = 0. 003）. Surgical operation was the main therapeutic method for both gastric and rectal carcinoids. The 3- and 5-year survival rates for rectal carcinoids were 92. 8% and 62. 3%,respectively,and those for gastric carcinoids were 62. 6% and 49. 2%,respectively; there were no significant differences between the two groups（ P 〉0. 05）.Conclusions： Gastrointestinal carcinoids enrolled in this study distributed mainly in rectum and stomac

关 键 词：胃肠肿瘤 类癌瘤 病理学 预后 回顾性研究 

分 类 号：R735[医药卫生—肿瘤]