直肠G2神经内分泌瘤患者的临床病理特征与预后  

Clinicopathological features and prognosis of rectal neuroendocrine tumor with grade 2

作　　者：罗振恺 张琦 马晓婷 向仁伸 陆帅兵 孔德扬 孙宇 冯英瑛 裴炜 冯林 朱玥璐 杨林 张海增 Luo Zhenkai;Zhang Qi;Ma Xiaoting;Xiang Renshen;Lu Shuaibing;Kong Deyang;Sun Yu;Feng Yingying;Pei Wei;Feng Lin;Zhu Yuelu;Yang Lin;Zhang Haizeng(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing100021,China;Department of Medical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing100021,China;State Key Laboratory of Molecular Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing100021,China;Department of Pathological Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing100021,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院内科,北京100021 [3]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院分子肿瘤学国家重点实验室,北京100021 [4]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院病理科,北京100021

出　　处：《中华肿瘤杂志》2025年第1期108-117,共10页Chinese Journal of Oncology

基　　金：国家自然科学基金(81972317);中国医学科学院医学与健康科技创新工程(2021-I2M-1-021,2021-I2M-1-018)。

摘　　要：目的分析直肠神经内分泌瘤(R-NET)G2的临床病理特征,探讨其影响预后的因素并总结相关治疗经验。方法回顾性分析中国医学科学院肿瘤医院2003年1月至2023年9月收治的经病理学诊断确诊为R-NET G2患者的临床资料。采用Fisher精确检验与Kaplan-Meier法对病理特征与预后间的关系进行分析。结果R-NET G2患者22例,随访时间为6~98个月,中位随访时间为42个月,随访期间有5例患者因肿瘤进展而死亡。患者的1、3、5年肿瘤特异性生存率分别为100.0%、92.9%、69.6%。22例患者中,有20例接受手术治疗,其中15例术后行辅助治疗;2例因肝、骨多发转移而行直接内科治疗。肿瘤长径≥2 cm、T2~3期、有淋巴结转移、有远处转移患者的5年生存率(分别为57.1%、68.8%、66.7%和63.6%)均短于肿瘤长径<2 cm、T1期、无淋巴结转移、无远处转移的患者(均为100.0%,均P<0.001)。此外,与无远处转移的患者相比,伴有肝转移患者的原发瘤长径较大,T分期较晚(P<0.05)。结论R-NET G2与G1相比恶性程度高,并且具有较高的转移倾向。临床医师应根据肿瘤大小、侵犯深度、淋巴结状态、存在远处转移以及远处转移的部位和程度等因素制定相应的诊疗策略。ObjectiveTo explore the clinicopathological features of rectal neuroendocrine tumor(R-NET)G2,identify prognostic factors,and summarize treatment experience.MethodsThe clinical data of patients diagnosed with R-NET G2 by pathological diagnosis admitted to Cancer Hospital of the Chinese Academy of Medical Sciences from January 2003 to September 2023 were retrospectively analyzed.The Fisher's exact test and Kaplan-Meier curves were performed to analyze the association between pathological features and prognosis.ResultsA total of 22 patients were enrolled in this study and 21 patients were followed up for a period of 6-98 months with a median follow-up time of 42 months.5 patients died due to tumor progression during the follow-up period.The 1-,3-,and 5-year cancer-specific survival(CSS)of the whole group were 100.0%,92.9%,and 69.6%,respectively.Of the 22 patients,20 underwent surgical treatment,of which 15 underwent postoperative adjuvant therapy;2 underwent medical treatment for liver and bone multiple metastases.The 5-year survival rates of patients with tumours≥2 cm in length,T2-3 stage,lymph node metastasis,and distant metastasis(57.1%,68.8%,66.7%,and 63.6%,respectively)were shorter than those of patients with tumours<2 cm in length,T1 stage,no lymph node metastasis,and no distant metastasis(all 100.0%,P<0.001).In addition,patients with liver metastases had larger primary tumor diameters and higher T-stages compared with those without distant metastasis(P<0.05).ConclusionsR-NET G2 has a high degree of malignancy compared with G1 and a high propensity for metastasis.Clinicians should formulate appropriate diagnostic and treatment strategies based on factors such as tumor size,depth of invasion,lymph node status,presence of distant metastasis,and the location and extent of distant metastasis.

关 键 词：直肠肿瘤 神经内分泌瘤 肝转移 预后 

分 类 号：R73[医药卫生—肿瘤]