467例胃肠道神经内分泌肿瘤的临床病理特征及淋巴结转移危险因素分析  

Clinicopathological features and risk factors of lymph node metastasis of gastrointestinal neuroendocrine neoplasms in 467 patients

作　　者：邓会岩 刘月平[1] 王心然 贾迎[1] 王贵英[2] 

机构地区：[1]河北医科大学第四医院病理科,石家庄050011 [2]河北医科大学第四医院外二科,石家庄050011

出　　处：《中华消化外科杂志》2017年第3期287-292,共6页Chinese Journal of Digestive Surgery

基　　金：河北省科技计划项目（14277710D）

摘　　要：目的：探讨胃肠道神经内分泌肿瘤（GINENs）的临床病理特征及淋巴结转移危险因素。方法：采用回顾性病例对照研究方法。收集2006年1月至2015年12月河北医科大学第四医院收治的467例GINENs患者的临床病理资料。观察指标：（1）GINENs的发生部位和病理学分型。（2）GINENs手术切除标本的病理学检查特征。（3）影响GINENs淋巴结转移的单因素和多因素分析：性别、年龄、肿瘤部位、肿瘤直径、病理学分级、病理学分期、肿瘤浸润深度。单因素分析采用x^2检验，多因素分析采用Logistic回归模型分析。结果：（1）GINENs的发生部位和病理学分型：467例GINENs患者中，肿瘤位于胃304例，十二指肠15例，小肠7例，结肠14例，直肠127例；肿瘤直径为0.3 cm～12.0 cm，平均直径为2.2 cm。467例 GINENs患者中，G1级神经内分泌瘤（NETs）209例，G2级NETs 64例，G3级神经内分泌癌（NECs）146例，混合性腺神经内分泌癌（MANECs）48例。467例GINENs淋巴结转移率为31.48%（147/467）。（2） GINENs手术切除标本的病理学检查特征： NETs属于高分化NENs，其瘤细胞特征性结构为实性巢状、小梁状或腺管状。细胞为均匀一致的小细胞或中等大小细胞，胞质中等量或丰富；核圆形或卵圆形，染色质颗粒状；核仁不明显；内分泌标记物表达阳性；瘤细胞巢周有丰富的小血管和纤维间质围绕。NECs属于低分化NENs。它包括小细胞癌和大细胞NEC。小细胞癌的细胞似淋巴细胞，小圆形或卵圆形，胞质稀少，核细颗粒状或深染，核分裂象常见。大细胞NEC的细胞体积大，常〉3个淋巴细胞，呈器官样、菊形团样排列，胞质丰富，染色质呈粗颗粒状，核仁明显，核分裂象易见，常伴大片状坏死。两者均不同程度阳性表达内分泌标记物。MANECs同时具有腺腔形成的传统型腺癌和NENs形态特点。467例GINENs患者免疫组织�Objective：To investigate the clinicopathological features and risk factors of lymph node metastasis of gastrointestinal neuroendocrine neoplasms （GINENs）. Methods：The retrospective casecontrol study was conducted. The clinicopathological data of 467 patients with GINENs who were admitted to the Fourth Hospital of Hebei Medical University from January 2006 to December 2015 were collected. Observation indicators：（1） occurrence sites and pathological classification of GINENs; （2） pathological characteristics of surgical specimens of GINENs; （3） univariate analysis and multivariate analysis affecting lymph node metastasis of GINENs： sex, age, tumor location, tumor diameter, pathological classification, pathological stage and tumor invasive depth. The univariate analysis and multivariate analysis were respectively done using the chisquare test and Logistic regression model. Results：（1） Occurrence sites and pathological classification of GINENs： of 467 patients with GINENs, tumors of 304, 15, 7, 14 and 127 patients were located at stomach, duodenum, small intestine, colon and rectum, respectively. Tumor diameter was 0.3-12.0 cm, with an average diameter of 2.2 cm. Of 467 patients with GINENs, G1 and G2 of neuroendocrine tumors （NETs）, G3 of neumendocfine carcinomas （NECs） and mixed adenoneuroendocfine carcinomas （MANECs） were respectively detected in 209, 64, 146 and 48 patients. Lymph node metastasis rate of GINENs was 31.48%（147/467）. （2） Pathological characteristics of surgical specimens of GINENs： NETs were highdifferentiated NENs. Cells of NETs were solid and nest, trabeculum and tubularshaped, and consisted of small or medium cells, with moderate amount or massive cytoplasms, round or oval nucleus, particleshaped chromatin, unobvious nucleolus and positive endocrine markers. There were abundant of small blood vessels and surrounding fibrous stroma in peripheral tumor cell nests. NECs were lowdifferentiated NENs and included small cell carcinoma and large cell

关 键 词：神经内分泌肿瘤 胃肠 病理学 淋巴结转移 

分 类 号：R735[医药卫生—肿瘤]