食管神经内分泌肿瘤的临床特征分析  

Analysis of clinical features of esophageal neuroendocrine neoplasms

作　　者：胡平 何娜 严丽军 李晓雅 柏建安 朱国琴 田野 汤琪云 Hu Ping;He Na;Yan Lijun;Li Xiaoya;Bai Jian'an;Zhu Guoqin;Tian Ye;Tang Qiyun(Department of Geriatric Gastroenterology,The First Affiliated Hospital with Nanjing Medical University,Nanjing210029,China)

机构地区：[1]南京医科大学第一附属医院老年消化科,南京210029

出　　处：《中华消化内镜杂志》2024年第12期1002-1007,共6页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金(82373180)。

摘　　要：为探索食管神经内分泌肿瘤(esophageal neuroendocrine neoplasms,eNENs)的临床特征及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在eNENs中的价值,回顾分析34例eNENs患者(2010年1月至2022年12月在南京医科大学第一附属医院经组织病理学确诊的30例患者及2014年1月至2023年12月PubMed中报道的行ESD治疗的4例eNENs患者)的临床病理特征与结局,通过生存分析确定影响eNENs预后的因素。结果显示,eNENs好发于老年男性(79.41%,27/34),发病年龄为(65.41±8.78)岁。病变多发生在食管中段(41.18%,14/34)和下段(41.18%,14/34)。吞咽困难是最常见的症状,占58.82%(20/34)。中位生存时间为36.31个月,一、三、五年生存率分别为82.35%、53.45%和27.94%。单因素分析显示不同部位、大小、分期及是否切除原发灶的eNENs预后差异有统计学意义( P<0.05)。多因素分析显示原发灶切除是影响eNENs预后的独立危险因素( P=0.041, HR=0.166,95% CI:0.030~0.927)。原发灶切除患者的中位生存时间显著长于未切除者(42.98个月比17.90个月, P=0.005),而外科手术患者与ESD切除原发肿瘤患者的中位生存时间差异无统计学意义(43.93个月比39.50个月, P=0.835)。以上结果表明eNENs临床表现缺乏特异性,原发灶切除可改善eNENs的预后。ESD在特定群体中可获得与外科手术相当的预后,可作为一种替代选择的治疗方法。To investigate the clinical features of esophageal neuroendocrine neoplasms(eNENs)and the role of endoscopic submucosal dissection(ESD)in the management of eNENs,clinicopathologic features and outcomes of 34 patients with eNENs(30 patients diagnosed by histopathology in the First Affiliated Hospital with Nanjing Medical University from January 2010 to December 2022 and 4 patients who underwent ESD reported in PubMed from January 2014 to December 2023)were retrospectively analyzed.Survival analysis was performed to identify prognostic factors of eNENs.The vulnerable patients of eNENs were elderly males(79.41%,27/34)and the age of onset was 65.41±8.78 years.The lesions mostly occurred in the middle(41.18%,14/34)and lower(41.18%,14/34)esophagus.Dysphagia was the most common clinical manifestation,accounting for 58.82%(20/34).The median overall survival time was 36.31 months and the 1,3,5-year overall survival rate was 82.35%,53.45%and 27.94%respectively.In the univariate analysis,the prognosis of eNENs varied in different location,size,stage and treatment strategies(P<0.05).The primary tumor resection was an independent prognostic factor for the survival of eNENs in multivariate analysis(P=0.041,HR=0.166,95%CI:0.030-0.927).The median survival time of the patients with primary tumor resection was significantly longer than that without resection(42.98 months VS 17.90 months,P=0.005).Whereas,there was no significant difference in median survival time between the patients who underwent surgical operation and those who underwent ESD(43.93 months VS 39.50 months,P=0.835).eNENs has no specific clinical manifestations.Resection of the primary tumor is a protective factor for the prognosis of eNENs.ESD has a comparable result to surgery and can be considered as a treatment modality for paticular patients.

关 键 词：食管肿瘤 神经内分泌瘤 癌 神经内分泌 预后 内镜黏膜下剥离术 化疗 

分 类 号：R73[医药卫生—肿瘤]