贲门混合性腺神经内分泌癌的临床病理特征 及预后影响因素分析  

Clinicopathological characteristics and prognostic factors of cardial mixed adenoneuroendocrine carcinoma

作　　者：孙阳阳[1] 钱留兰 顾文贤[1] 王更芳[1] 高蔚[1] 耿翔[3] 张旭东 周晓莉[1] Sun Yangyang;Qian Liulan;Gu Wenxian;Wang Gengfang;Gao Wei;Geng Xiang;Zhang Xudong;Zhou Xiaoli(Department of Pathology,Changzhou No.2 People′s Hospital,Nanjing Medical University,Changzhou 213000,Jiangsu Province,China;Department of Science and Education,Changzhou No.2 People′s Hospital,Nanjing Medical University,Changzhou 213000,Jiangsu Province,China;Department of General Surgery,Changzhou No.2 People′s Hospital,Nangjing Medical University,Changzhou 213000,Jiangsu Province,China)

机构地区：[1]南京医科大学附属常州市第二人民医院病理科,213000 [2]南京医科大学附属常州市第二人民医院科教科,213000 [3]南京医科大学附属常州市第二人民医院普通外科,213000

出　　处：《中华消化外科杂志》2019年第12期1163-1170,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金青年基金项目(81702323)。

摘　　要：目的:探讨贲门混合性腺神经内分泌癌(MANEC)的临床病理特征和预后影响因素。方法:采用回顾性描述性研究方法。收集2008年1月至2018年1月南京医科大学附属常州市第二人民医院收治的34例原发性贲门MANEC患者的临床病理资料;男20例,女14例;平均年龄为66岁,年龄范围为39~81岁。34例患者均行贲门癌切除术,术后行组织病理学检查。观察指标:(1)手术及治疗情况。(2)临床表现和病理学情况。(3)手术切除标本病理学检查情况。(4)随访和生存情况。(5)预后影响因素分析。采用门诊和电话方式进行随访,了解患者生存情况及肿瘤复发和转移情况。随访时间截至2018年12月。正态分布的计量资料以±s表示;偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。采用Kaplan-Merier法计算生存时间和生存率,并绘制生存曲线。采用Log-rank检验进行生存情况分析。采用COX比例风险模型进行单因素和多因素分析。结果:(1)手术及治疗情况:所有患者顺利完成手术,且术后辅以顺铂+依托泊甙类为主的全身化疗。(2)临床表现和病理学情况:所有患者临床表现以腹上区不适、腹痛、腹胀为首发症状。34例患者中,男性、年龄≥60岁、累及食管、微卫星检测稳定、CA199升高、癌胚抗原升高、肿瘤病理学TNM分期Ⅲ~Ⅳ期、肿瘤直径≥5 cm、脉管内癌栓、淋巴结转移阳性、神经侵犯分别为20、29、31、28、4、3、29、30、27、30、29例。(3)手术切除标本病理学检查情况:所有患者的肿瘤以溃疡型为主,肿瘤直径为3.0~8.4 cm。34例患者中,1例浸润至黏膜下层,5例浸润至肌层,18例浸润至浆膜层,10例浸润至浆膜层外纤维脂肪组织。显微镜下检查结果:所有患者由腺癌和神经内分泌癌2种成分构成,并且2种成分占比均>30%。34例患者的腺癌成分中,14例为低分化管状腺癌,6例为黏液腺癌,6例为中分化管状腺�Objective:To investigate the clinicopathological characteristics of cardial mixed adenoneuroendocrine carcinoma(MANEC)and analyze its prognostic factors.Methods:The retrospective and descriptive study was conducted.The clinicopathological data of 34 patients with primary cardial MANEC who were admitted to the Changzhou No.2 People′s Hospital of Nangjing Medical University from January 2008 to January 2018 were collected.There were 20 males and 14 females,aged from 39 to 81 years,with an average age of 66 years.All the 34 patients underwent resection of cardia cancer and postoperative pathological examination.Observation indicators:(1)surgery and treatment;(2)clinical manifestations and pathological conditions;(3)pathological examination of surgical resection specimens;(4)followup and survival;(5)analysis of prognostic factors.Followup using outpatient examination and telephone interview was conducted to detect the survival of patients and tumor recurrence and metastasis up to December 2018.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were expressed as M(range).Count data were expressed as absolute numbers or percentages.Kaplan-Merier method was used to calculate the survival time and rate and draw the survival curve,and logrank test was used for the survival analysis.Univariate and multivariate analyses were performed using the COX proportional risk model.Results:(1)Surgery and treatment:all the patients underwent surgery successfully and postoperative systemic chemotherapy based on cisplatin+etoposide.(2)Clinical manifestations and pathological conditions:patients had epigastric discomfort,abdominal pain and abdominal distension as the first symptoms.Of 34 patients,number of males,cases with age≥60 years,cases with esophageal involvement,cases with stable microsatellite,cases with higher CA199,cases with elevated cancer embryonic antigen,cases of tumor pathologic TNM stageⅢ-Ⅳ,cases with tumor diameter≥5 cm,cases with vascular tumor emb

关 键 词：神经内分泌肿瘤 混合性腺神经内分泌癌 临床病理特征 预后 分析基 

分 类 号：R73[医药卫生—肿瘤]