265例神经内分泌肿瘤的临床病理特征及预后分析  

Clinicopathological features and risk factors of neuroendocrine tumors in 256 patients

作　　者：宇永军[1] 张诗武[2] 李玉玮[1] 许晨[1] 张培达[1] 张锡朋[1] 

机构地区：[1]天津市人民医院肛肠外科,300121 [2]天津市人民医院病理科,300121

出　　处：《天津医药》2018年第1期65-69,共5页Tianjin Medical Journal

摘　　要：目的探讨神经内分泌肿瘤(NETs)的发病特点、临床表现、诊断和治疗方法及预后。方法回顾性分析2006年1月—2015年8月天津市人民医院265例NETs患者的临床资料,包括性别、年龄、入院临床症状、原发部位、病理诊断、治疗情况和预后随访情况。结果 265例NETs患者中男160例,女105例,平均发病年龄(55.8±2.7)岁,发病高峰55~65岁。发病部位主要位于结直肠127例(47.9%),肺部59例(22.3%),胃21例(7.8%),阑尾15例(5.7%),小肠(特别是十二指肠及胰腺)10例(3.8%),乳腺11例(4.2%),颈部10例(3.8%),其他部位12例(4.5%)。各个不同部位患者的就诊症状各不相同。结直肠患者主要是排便习惯改变,如腹泻、便秘、便血等。肺原发患者多表现为咳嗽或痰中带血。胃、阑尾或小肠原发患者多表现为腹痛、腹胀等不适。病理诊断G1期186例(70.2%),G2期54例(20.4%),G3期25例(9.4%)。免疫组化显示突触素(Syn)阳性228例(86.4%),嗜铬粒蛋白A(Cg A)阳性102例(38.5%),CD56阳性74例(27.9%)。232例患者进行了手术治疗(87.5%),28例患者接受了放疗或化疗治疗(10.6%),5例患者未行治疗。198例患者完成至少1次随访,随访率74.7%,中位随访时间为38个月,G1期随访患者中无肿瘤相关性死亡;G2期有6例肿瘤相关性死亡;G3期中有19例肿瘤相关性死亡。所有肿瘤相关性死亡患者中23例发生了转移。神经内分泌瘤(G1+G2)的生存率明显高于神经内分泌癌(G3)(Log rankχ2=13.774,P<0.01)。结论 NETs患者男性多于女性,不同部位的患者发病临床表现各不相同,消化道特别是结直肠是高发部位;病理分期越晚的患者预后越差。Objective To investigate the epidemiology, clinical manifestations, diagnosis, treatment and prognosis ofneuroendocrine tumors(NETs).MethodsMedical records of 265 patients with neuroendocrine tumors diagnosed andtreated in our hospital from January 2006 to August 2015 were collected and retrospectively reviewed in this study. Theclinicopathological data including gender, age of onset, initial symptoms, primary site, pathological conditions, diagnosis,treatment, prognosis and follow up were analyzed.ResultsThe gender ratio M/F of the 265 cases was 160∶105(1.5∶1),with mean age of(55.8±2.7) years, and the high incidence was in age of 55-65 years. The tumors were located in the colonand rectum(127 cases, 47.9%), lung(59 cases, 22.3%), stomach(21 cases, 7.8%), appendix(15 cases, 5.7%), small intestine(especially in the duodenum and pancreas, 10 cases, 3.8%), mammary gland(11 cases, 4.2%), neck(10 cases, 3.8%) andunknown primary site(12 cases, 4.5%). Patients with different tumor sites showed different symptoms. Patients withcolorectal tumors mainly manifested as changes in bowel habits, such as diarrhea, constipation and blood in stool. The mainmanifestation of patients with primary pulmonary symptoms was cough or bloody sputum. The patients with tumors atstomach, appendix or small intestine showed many discomfort, such as abdominal pain and abdominal distention. Among the265 cases, 186 patients were diagnosed as phase G1(70.2%), 54 patients were diagnosed as phase G2(20.4%) and 25 patients were diagnosed as phase G3(9.4%). Immunohistochemistry showed that synaptophysin(Syn) was positive in 228 cases(86.4%), chromaffin A(Cg A) was positive in 102 cases(38.5%), and C56 was positive in 74 cases(27.9%). A total of232 patients were treated with surgery(87.5%), 28 patients received radiotherapy or chemotherapy treatment(10.6%) and 5 patients were not treated. One hundred and ninety-eight patients were followed up at least 1 time, and the follow-up rate was74.7%. The median follow-up time was 38 months. No tumor relate

关 键 词：神经内分泌瘤 临床表现 病理学 预后 

分 类 号：R73[医药卫生—肿瘤]