266例胃肠胰神经内分泌肿瘤临床特征及预后分析  

Analysis of clinical features and prognosis of 266 cases of gastroenteropancreatic neuroendocrine neoplasms

作　　者：弋东敏 肖伟 周胜理 李杜鹃 张炳勇[1] 李健[1] YI Dongmin;XIAO Wei;ZHOU Shengli;LI Dujuan;ZHANG Bingyong;LI Jian(Department of Gastroenterology People’s Hospital of Zhengzhou University,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Pathology,People’s Hospital of Zhengzhou University,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院消化内科,河南郑州450003 [2]河南省人民医院病理科,河南郑州450003

出　　处：《胃肠病学和肝病学杂志》2018年第4期439-444,共6页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的分析266例胃肠胰神经内分泌肿瘤(gastroenteropancreatic neuroendocrine neoplasms,GEP-NENs)的临床病理特征及诊治,筛选影响其转移和预后的危险因素,旨在进一步提高对本病的认识、早期诊断率。方法回顾性分析2012年3月至2017年4月河南省人民医院收治的266例GEP-NENs患者临床资料。采用Logistic回归筛选肿瘤转移的危险因素,采用Log-rank进行生存分析,COX比例风险模型分析预后因素。结果 266例GEP-NENs中,男女比1.6∶1,发病年龄(54.9±13.8)岁。发病部位以胰腺最多见(26.7%),其次为直肠(24.4%)和胃(24.4%)。功能性GEP-NENs占12.0%,均为胰岛细胞瘤,表现为低血糖相关症状,无功能性GEP-NENs占88.0%,临床表现无特异性,以腹痛、腹胀、最常见(42.9%,114/266)。内镜在胃肠道NENs的病灶检出率高达98.3%。所有食管NENs(21/21)和胆道NENs(10/10)为G_3级,大多数胃(67.7%,44/65)NENs为G_3级;胰腺(84.5%,60/71)、直肠(96.9%,63/65)及十二指肠(71.4%,15/21)多为神经内分泌瘤(neuroendocrine tumor,NET)G_1或G_2级。多因素Logistic回归分析显示,肿瘤分级、分类及肿瘤大小是预测转移的独立危险因素。COX回归分析显示,年龄及转移是评估GEP-NENs患者预后的独立危险因素。结论 GEP-NENs的发病部位以胰腺、直肠和胃多见。不同原发部位的病理分级差异较大,其中食管、胆道和胃NENs多为分化差的神经内分泌癌(neuroendocrine cancer,NEC)。肿瘤分级、分类和肿瘤大小是转移的独立预测因子,年龄大和转移的患者生存预后最差。Objective To analyze the clinicopathologic characteristics,diagnosis and treatment of 266 cases of gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs),and to screen the risk factors affecting metastasis and prognosis.To further improve the knowledge and the early diagnostic rate of the tumors.Methods Two hundred and sixty-six patients with GEP-NENs treated in Henan Provincial People’s Hospital from Mar.2012 to Apr.2017 were analyzed retrospectively.Logistic regression was performed to identify risk factors for metastasis of the tumors.The Log-rank test was used for survival analysis.The COX proportional risk model was used to analyze the prognostic factors.Results The male-to-female ratio was 1.6∶1 and the age was(54.9±13.8)years.The most common tumor site was the pancreas(26.7%),followed by the rectum(24.4%)and stomach(24.4%).12.0%of patients which suffered from insulinoma presented functional tumors with hypoglycemia symptoms.Most patients(88.0%)presented non-functional tumors with non-specific symptoms.The most common symptom was abdominal pain and distention(42.9%,114/266).Endoscopy was used in the gastrointestinal NENs with high lesion detection rate(98.3%).All the esophagus NENs(21/21),biliary tract NENs(10/10),and most stomach NENs(67.7%,44/65)were G 3;while pancreas(84.5%,60/71),rectum(96.9%,63/65)and duodenum(71.4%,15/21)NENs were well-differentiated NET G 1 or G 2.Multivariate Logistic regression analysis showed that the independent risk factors for metastasis prediction included tumor classification,classification and tumor size.COX regression analysis showed that age and metastasis were independent risk factors for prognosis of GEP-NENs patients.Conclusion Pancreas,rectum and stomach are more commom sites of GEP-NENs.Difference in pathological grading is considerable in different primary sites of tumors,and most NENs from esophagus,biliary tract and stomach are poorly-differentiated NEC.Tumor classification and size are independent predictors of metastasis,and the survival of patients with

关 键 词：胃肠胰腺神经内分泌肿瘤 临床病理特征 转移 预后 

分 类 号：R735[医药卫生—肿瘤]