伴神经内分泌分化胃癌的临床病理特征及预后分析  

Clinicopathological characteristics and prognosis of gastric cancer with neuroendocrine differentiation

作　　者：陈美丽 杨觅 陈洁宇[1,3] 禹立霞 钱晓萍[1,2] 刘宝瑞 刘琳[1,4] CHEN Meili;YANG Mi;CHEN Jieyu;YU Lixia;QIAN Xiaoping;LIU Baorui;LIU Lin(School of Medicine,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学医学院,南京210009 [2]南京大学医学院附属鼓楼医院肿瘤中心暨南京大学临床肿瘤学研究所,210008 [3]南京大学医学院附属鼓楼医院病理科,210008 [4]东南大学附属中大医院肿瘤科,210009

出　　处：《临床肿瘤学杂志》2018年第7期615-620,共6页Chinese Clinical Oncology

基　　金：国家自然科学基金资助项目(81272741);国家重点研发计划(2017YFA0205500);南京市医学科技发展杰出青年项目(JQX14001)

摘　　要：目的比较伴与不伴神经内分泌分化(NED)胃癌患者的临床病理特征及预后。方法回顾性分析2010年1月至2017年8月就诊于南京鼓楼医院伴NED 98例胃癌患者和同期不伴NED 338例患者的临床病理资料,比较两组患者临床病理特征的差异,Kaplan-Meier法进行生存分析并行Log-rank检验,Cox风险比例回归模型分析影响预后的独立影响因素。结果伴与不伴NED的两组胃癌患者均具有以下特征:起病症状相似,年龄<65岁和肿瘤直径≥4 cm更多见,神经浸润比例较高及淋巴结和远处转移比例相仿;而两组在性别、组织学类型、T分期、TNM分期及脉管浸润等方面的差异有统计学意义(P<0.05)。Cg A、Syn的阳性率分别为70.4%、75.5%,共同阳性率为45.9%。生存分析显示伴NED胃癌患者术后1、3、5年生存率分别为73.5%、46.2%、34.2%,明显低于不伴NED胃癌患者的88.9%、64.1%、53.7%,差异有统计学意义(P<0.05)。单因素预后分析结果显示,伴NED胃癌患者的预后与年龄、肿瘤直径、分化程度、TNM分期、脉管和神经是否浸润有关(P<0.05)。多因素分析结果显示,年龄是影响伴NED胃癌患者预后的独立因素(P<0.05)。结论免疫组化染色是判定胃癌伴NED的主要方法,伴NED胃癌患者预后较差。Objective To compare the differences in clinicopathological characteristics and prognosis between gastric cancer with and without neuroendocrine differentiation(NED).Methods From January 2010 to August 2017,98 gastric cancer with NED and 338 gastric cancer without NED patients with data of clinicopathological characteristics from Nanjing Drum Tower Hospital were collected.The clinicopathological characteristics between the two groups of patients were compared by chi-square test.Survival rate was calculated by Kaplan-Meier curve,univariate and multivariate prognostic risk factors were analyzed by Log-rank test and Cox regression model.Results The two groups of gastric cancer patients with and without NED had the following common characteristics:similar onset symptoms,more younger than 65 years old,more bigger than or equal to 4 cm tumor size,high proportion of nerve invasion,and the rates of lymph node and distant metastasis were similar.However,there were some significant diferences in gender,histological types,T stage,tumor TNM stage and vascular invasion between this two groups(P<0.05).The positive expression rates of CgA and Syn were 70.4%and 75.5%,both expression rate was 45.9%.The 1,3 and 5 years survival rates in gastric cancer patients with NED were 73.5%,46.2%and 34.2%,lower than 88.9%,64.1%and 53.7%in those without NED,and the differences were significant(P<0.05).Univariate analysis showed that age,tumor size,differentiation,TNM stage,vascular and nerve invasion were associated with prognosis of gastric cancer with NED(P<0.05).Multivariate analysis showed that age was an independent factor affecting the prognosis(P<0.05).Conclusion Immunohistochemistry is the main method to diagnose gastric cancer with NED.Gastric cancer patients with NED may have poor prognosis.

关 键 词：胃癌 神经内分泌分化 预后 嗜铬蛋白A 突触素 

分 类 号：R735.2[医药卫生—肿瘤]