83例淋巴结阴性直肠神经内分泌肿瘤的临床病理特征  

Clinicopathological characteristics of 83 lymph node-negative rectal neuroendocrine tumors

作　　者：韩登 苏雯婷 李靖涛[3] 王超 祁志荣 罗杰[4] 谭煌英[2] Deng Han;Wenting Su;Jingtao Li;Chao Wang;Zhirong Qi;Jie Luo;Huangying Tan(Beijing University of Chinese Medicine,Beijing 100029,China;Department of Integrative Oncology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Gastroenterology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pathology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京市100029 [2]中日友好医院中西医结合肿瘤内科 [3]中日友好医院消化科 [4]中日友好医院病理科

出　　处：《中国肿瘤临床》2020年第8期388-392,共5页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金项目(编号:81673763)资助。

摘　　要：目的:探讨淋巴结阴性直肠神经内分泌肿瘤(rectal neuroendocrine neoplasms,R-NENs)的临床病理特征。方法:回顾性分析2012年12月至2019年12月中日友好医院83例淋巴结阴性R-NENs患者的临床病理资料,并定期随访。结果:83例患者中男性49例(59.0%)、女性34例(41.0%);平均年龄(43.3±11.4)岁;61例(75.5%)患者主要因非特异性症状就诊;肿瘤单发75例(90.4%);肿瘤平均直径为(0.8±0.7)cm;主要浸润黏膜层及黏膜下层80例(96.4%);病理分级以G1为主,共65例(78.3%),Ki-67指数平均值为(2.1±1.7)%;肿瘤分期Ⅰ期78例(94.0%)。免疫组织化学法检测CgA阳性29例(34.9%)。治疗方式使用内镜下切除67例(80.7%),手术16例(19.3%)。中位随访时间24(3~90)个月,5年生存率100%,2例(2.4%)复发。肿瘤复发与Ki-67阳性指数具有显著相关性(P=0.025);肿瘤浸润深度与肿瘤直径具有相关性(P=0.030)。Kaplan-Meier法分析得出治疗方式、肿瘤分级对预后复发的差异具有统计学意义(P=0.031、0.001)。结论:淋巴结阴性R-NENs直径>1.0 cm相对容易浸及固有肌层,直径≤1.0 cm也有浸及固有肌层的可能,建议此类患者行超声内镜(EUS)检查以决定治疗方式。内镜下切除为淋巴结阴性R-NENs的主要治疗方式,Ki-67指数较高患者治疗后相对容易复发。Objective:To explore the clinicopathological characteristics of lymph node-negative rectal neuroendocrine neoplasms(RNENs).Methods:We retrospectively analyzed and regularly followed up the clinical and pathological data of 83 patients with lymph node-negative rectal NENs treated at China-Japan Friendship Hospital between December 2012 to December 2019.Results:Among the 83 patients,49(59%)were male and 34(41%)were female with an average age of(43.3±11.4)years.Of the patients,61(75.5%)were mainly treated for nonspecific symptoms,75(90.4%)had a single tumor with an average size of(0.8±0.7)cm,80(96.4%)showed tumor infiltration into the mucosal and submucosal layers,and 65(78.3%)predominantly had tumors of pathological grade G1.The average Ki-67 index was(2.1±1.7)%,with 78(94%)patients having stage I tumors.Twenty-nine(34.9%)patients showed CgA positivity on immunohistochemical analysis.As for treatment,67(80.7%)patients underwent endoscopic resection,and 16(19.3%)patients underwent surgery.The median follow-up time was 24(3-90)months,with a 100%5-year survival rate and relapse in 2(2.4%)patients.Tumor recurrence was significantly correlated with the Ki-67 positive index(P=0.025),and tumor infiltration depth was correlated with the tumor diameter(P=0.03).Kaplan-Meier analysis showed that different treatment mode and tumor grade on prognosis and recurrence was statistically significant(Log-rank P=0.031,0.001).Conclusions:Lymph node-negative rectal neuroendocrine neoplasms with a diameter>1 cm infiltrate the muscularis propria relatively easily and those≤1 cm may also infiltrate the muscularis propria.It is recommended that all patients undergo ultrasound enteroscope(EUS)to determine the treatment choice.Endoscopic resection is the main treatment for lymph node-negative rectal neuroendocrine neoplasms.Patients with a high Ki-67 index are relatively prone to relapse after treatment.

关 键 词：直肠神经内分泌肿瘤 淋巴结阴性 临床病理特征 治疗 预后 

分 类 号：R735.37[医药卫生—肿瘤]