104例胃神经内分泌肿瘤的临床病理特征及预后分析  

Clinicopathologic features and prognostic analysis of 104 patients with gastric neuroendocrine neoplasms

作　　者：梁文全[1] 高云鹤[1] 李佶阳[1] 崔建新[1] 郗洪庆[1] 蔡爱珍[1] 陈凛[1] 

机构地区：[1]解放军总医院普通外科,北京100853

出　　处：《中华胃肠外科杂志》2016年第4期427-431,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81272698）;国家卫生行业科研专项（201302016）;全军医学科技“十二五”科研重点项目（BWS12J049）;国家高技术研究发展计划（863计划）（2012AA02A504）

摘　　要：目的探究胃神经内分泌肿瘤（gNEN）的临床病理特征及预后影响因素。方法回顾性分析2000年1月至2014年12月在北京解放军总医院经病理检查确诊并接受住院治疗的104例gNEN患者的临床病理资料。观察患者肿瘤的增殖活性分级（G1、G2和G3）及TNM分期情况。分别采用Log-rank检验和Cox回归模型对可能影响预后的临床病理特征进行单因素和多因素分析。结果全组患者中，神经内分泌癌66例（63．5％），混合性腺神经内分泌癌25例（24．O％），神经内分泌瘤12例（11．5％）；G1级4例（3．8％），G2级8例（7．7％），G3级92例（88．5％）。TNM分期结果显示，I期6例（5．8％），ⅡA期6例（5．8％），ⅡB期9例（8．7％），ⅢA期8例（7．7％），ⅢB期55例（52．9％）及Ⅳ期20例（19．2％）。肿瘤浸润深度：T1期7例（6．7％）、T2期12例（11．5％）、T3期24例（23．1％）及T4期61例（58．7％）。有淋巴转移者73例（70．2％），发生远处转移者20例（19．2％）。全组86例（83％）患者获得随访，随访6-186月，结果显示，患者中位生存时间为33．0（95％CI：28．3～36．6）月；1、3和5年生存率分别为80％、49％和31％。单因素分析结果显示，肿瘤直径、肿瘤分型和增殖活性分级、肿瘤浸润深度（均P〈0．05）和肿瘤免疫组织化学检测嗜铬颗粒A、肿瘤分期、淋巴结转移及远处转移（均P〈0．01）是影响患者生存的危险因素；多因素Cox回归分析显示，肿瘤分期是患者生存率的独立影响因素（RR=14．213，95％CI：1．316-153．524；P=0．029）。结论病理分期晚是gNEN的临床特点及影响其预后的主要因素。Objective To investigate the clinicopathologic features and prognostic factors of gastric neuroendocrine neoplasms （gNENs）. Methods Clinicopathologic data of 104 patients with gastric neuroendoerine neoplasms admitted in Chinese PLA General Hospital between January 2000 and December 2014 were analyzed retrospectively. Tumor proliferation activity classification （G1, G2 and G3） and TNM staging were observed. The clinicopathologic features of the whole group were coUeeted and the univariate and multivariate analysis were determined by Log-rank and Cox proportional hazard model to detect the prognosis-determining features. Results Of all the patients, 66 cases （63.5%） were neuroendoerine carcinoma, 25 cases （24.0%） were mixed adenoendocrine carcinoma and 12 cases （11.5%） were neuroendocrine tumor. For G grades, 92 cases （88.5%） were G3 grade, 8 eases（7.7%） were G2 grade and 4 eases （3.8%） were G1 grade. TNM staging results showed that stageI was found in 6 cases （$.8%）, stage IIA in 6 cases （5.8%）, stagell B in 9 cases （8.7%）, stage Ⅲ A in 8 cases （7.7%）, stage IUB in 55 cases （52.9%） and stage Ⅱ in 20 cases （19.2%）. For T stage, 7 cases （6.7%） were TI, 12 cases （11.5%） were T2, 24 cases （23.1%） were T3, and 61 cases （58.7%） were T4. Lymph node metastasis occurred in 73 cases （70.2%） and distant metastasis occurred in 20 cases （19.2%）. Eighty-six patients were followed up for 6 to 186 months. The median survival was 33.0 months （95% CI： 28.3 to 36.6）, and 1-, 3-, and 5-year survival rates were 80%, 49% and 31%. Clinicopathologic features which were considered statistically significant on univariate analysis were selected to Cox proportional hazard model. Univariate analysis showed that risk factors of reducing survival rate included tumor size, pathological type, proliferation activity grades, and depth of invasion （all P 〈 0.05）, as well as chromogranin A expression, tumor staging, lymph node metastasis and distant metas

关 键 词：神经内分泌肿瘤 胃 临床病理特征 预后 

分 类 号：R735.2[医药卫生—肿瘤]