不同临床分型胃神经内分泌肿瘤的临床病理特征及预后分析
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摘要
背景近年来,胃神经内分泌肿瘤(neuroendocrine neoplasm,NEN)的发病率呈上升趋势.胃NEN具有明显的异质性,不同临床分型的胃NEN的临床病理特点及预后各不相同,结合国内外诊断标准,中国临床分型专家建议分4型.研究不同临床分型胃NEN的临床病理特点,对胃NEN患者的诊断和治疗具有重要意义.目的探讨不同临床分型胃NEN的临床病理特征,筛选转移危险因素,分析各型患者的预后.方法回顾性分析2011-2017年在郑州大学第一附属医院就诊的160例胃NEN患者的临床病理资料及随访资料,采用4型分类法将胃NEN分为4个基本类型,采用χ~2检验、t检验分析不同分型胃NEN的临床病理特征差异, Logistic回归分析转移危险因素, Kaplan-Meier法和Log-rank检验进行生存分析.结果全组160例胃NEN患者中,平均年龄为(58.3±10.8)岁,Ⅰ型41例(25.9%),Ⅱ型8例(5.1%),Ⅲ型25例(15.8%),Ⅳ型84例(53.2%),未明确分型者2例.Ⅰ、Ⅱ、Ⅲ、Ⅳ型肿瘤最大径中位数(下四分位数,上四分位数)分别为0.5 cm(0.3 cm, 0.7 cm)、1.5 cm(1.0 cm, 1.9 cm)、3.5 cm(2.0 cm, 4.8 cm)、5.0 cm(3.0 cm, 7.0 cm),四者比较差异有统计学意义(χ~2=64.532, P=0.000).150例报告转移情况的患者中,发生转移者83例,各型胃NEN患者中,有2例患者失访,156例患者获得随访,随访率98.7%,随访时间为1 mo-62 mo.截至随访结束,Ⅰ型患者总体生存率为97.6%(40/41),Ⅱ型患者总体生存率为85.7%(6/7),Ⅲ型患者总体生存率为64.0%(16/25),Ⅳ型患者总体生存率为55.4%(46/83).结论肿瘤最大径是转移的重要预测因素,不同分型胃NEN患者的预后不同,Ⅰ型和Ⅱ型预后较好,Ⅲ型和Ⅳ型预后较差,男性患者Ⅳ型多见.
BACKGROUND In recent years, the incidence of gastric neuroendocrine neoplasms(NENs) is on the rise. Gastric NENs have obvious heterogeneity. The clinicopathological characteristics and prognosis of gastric NEN of different clinical classifications are different. According to the diagnostic criteria developed by both Chinese and foreign scholars, Chinese clinical classification experts suggest four types of gastric NENs. Studying the clinicopathological characteristics of gastric NENs of different clinical classifications is of great significance for the diagnosis and treatment of patients with gastric NENs.AIM To investigate the clinicopathological characteristics, to screen risk factors for metastasis, and to analyze the prognosis of gastric NENs of different clinical classifications.METHODS Clinicopathological and follow-up data of 160 patients with gastric NENs admitted to The First Affiliated Hospital of Zhengzhou University from 2011 to 2017 were retrospectively analyzed. Gastric NENs were classified into four basic types by using the four-type classification. The χ2 and t tests were used to analyze differences in clinicopathological characteristics of gastric NENs of different clinical classifications. Logistics regression method was used to analyze the risk factors for metastasis. Kaplan-Meier method and Log-rank test were used for survival analysis.RESULTS The average age of 160 patients with gastric NENs was 58.3 years ± 10.8 years. Of 160 gastric NEN cases, there were two cases that were not clearly classified, 41 cases(25.9%) of type Ⅰ, 8 cases(5.1%) of type Ⅱ, 25 cases(15.8%) of type Ⅲ, and 84 cases(53.2%) of type Ⅳ. The median(lower quartile, upper quartile) diameter of types Ⅰ, Ⅱ, Ⅲ, and Ⅳ tumors was 0.5 cm(0.3 cm, 0.7 cm), 1.5 cm(1.0 cm, 1.9 cm), 3.5 cm(2.0 cm, 4.8 cm), and 5.0 cm(3.0 cm, 7.0 cm), respectively, and the difference was statistically significant(χ2 = 64.532, P = 0.000). Of 150 patients, 83 had metastasis. Of 158 cases, 156 patients were followed, with a follow-up rate being 98.7%, and the follow-up period was 1 to 62 mo. At the end of follow-up(December 31, 2017), the overall survival rate was 97.6%, 85.7%, 64.0%, and 55.4% for types Ⅰ, Ⅱ, Ⅲ, and Ⅳ tumors, respectively.CONCLUSION The maximum diameter of tumor is an important predictor of metastasis. The prognosis of patients with gastric NENs of different types is different. The prognosis of types Ⅰ and Ⅱ is better than that of types Ⅲ and Ⅳ, and type Ⅳ is more common in male patients.
BACKGROUND In recent years, the incidence of gastric neuroendocrine neoplasms(NENs) is on the rise. Gastric NENs have obvious heterogeneity. The clinicopathological characteristics and prognosis of gastric NEN of different clinical classifications are different. According to the diagnostic criteria developed by both Chinese and foreign scholars, Chinese clinical classification experts suggest four types of gastric NENs. Studying the clinicopathological characteristics of gastric NENs of different clinical classifications is of great significance for the diagnosis and treatment of patients with gastric NENs.AIM To investigate the clinicopathological characteristics, to screen risk factors for metastasis, and to analyze the prognosis of gastric NENs of different clinical classifications.METHODS Clinicopathological and follow-up data of 160 patients with gastric NENs admitted to The First Affiliated Hospital of Zhengzhou University from 2011 to 2017 were retrospectively analyzed. Gastric NENs were classified into four basic types by using the four-type classification. The χ2 and t tests were used to analyze differences in clinicopathological characteristics of gastric NENs of different clinical classifications. Logistics regression method was used to analyze the risk factors for metastasis. Kaplan-Meier method and Log-rank test were used for survival analysis.RESULTS The average age of 160 patients with gastric NENs was 58.3 years ± 10.8 years. Of 160 gastric NEN cases, there were two cases that were not clearly classified, 41 cases(25.9%) of type Ⅰ, 8 cases(5.1%) of type Ⅱ, 25 cases(15.8%) of type Ⅲ, and 84 cases(53.2%) of type Ⅳ. The median(lower quartile, upper quartile) diameter of types Ⅰ, Ⅱ, Ⅲ, and Ⅳ tumors was 0.5 cm(0.3 cm, 0.7 cm), 1.5 cm(1.0 cm, 1.9 cm), 3.5 cm(2.0 cm, 4.8 cm), and 5.0 cm(3.0 cm, 7.0 cm), respectively, and the difference was statistically significant(χ2 = 64.532, P = 0.000). Of 150 patients, 83 had metastasis. Of 158 cases, 156 patients were followed, with a follow-up rate being 98.7%, and the follow-up period was 1 to 62 mo. At the end of follow-up(December 31, 2017), the overall survival rate was 97.6%, 85.7%, 64.0%, and 55.4% for types Ⅰ, Ⅱ, Ⅲ, and Ⅳ tumors, respectively.CONCLUSION The maximum diameter of tumor is an important predictor of metastasis. The prognosis of patients with gastric NENs of different types is different. The prognosis of types Ⅰ and Ⅱ is better than that of types Ⅲ and Ⅳ, and type Ⅳ is more common in male patients.
引文
1中国临床肿瘤学会神经内分泌肿瘤专家委员会.中国胃肠胰神经内分泌肿瘤专家共识(2016年版).临床肿瘤学杂志2016;21:927-946[DOI:10.3969/j.issn.1009-0460.2016.10.013]
2 Yao JC,Hassan M,Phan A,Dagohoy C,Leary C,Mares JE,Abdalla EK,Fleming JB,Vauthey JN,Rashid A,Evans DB.One hundred years after"carcinoid":epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States.J Clin Oncol 2008;26:3063-3072[PMID:18565894 DOI:10.1200/JCO.2007.15.4377]
3 Modlin IM,Lye KD,Kidd M.A 5-decade analysis of 13,715carcinoid tumors.Cancer 2003;97:934-959[PMID:12569593DOI:10.1002/cncr.11105]
4 Niederle MB,Hackl M,Kaserer K,Niederle B.Gastroenteropancreatic neuroendocrine tumours:the current incidence and staging based on the WHO and European Neuroendocrine Tumour Society classification:an analysis based on prospectively collected parameters.Endocr Relat Cancer 2010;17:909-918[PMID:20702725 DOI:10.1677/ERC-10-0152]
5谭煌英,娄彦妮,罗杰,刘继喜,贾立群.胃神经内分泌肿瘤的分型诊断和治疗.中国医学前沿杂志(电子版)2014;11:4-8[DOI:10.3969/j.issn.1674-7372.2014.11.003]
6 Bosman FT,Carneiro F,Hruban RH,Theise ND.WHOclassification of tumours of the digestive system.4th ed.Lyon:IARC press;2010:13-14
7 2013年中国胃肠胰神经内分泌肿瘤病理诊断共识专家组.中国胃肠胰神经内分泌肿瘤病理诊断共识(2013版).中华病理学杂志2013;42:691-694[DOI:10.3760/cma.j.issn.0529-5807.2013.10.011]
8陈洛海,周志伟,陈洁.美国癌症联合委员会(AJCC)第8版胃肠胰神经内分泌肿瘤分期解读及评价.中华胃肠外科杂志2017;20:972-976[DOI:10.3760/cma.j.issn.1671-0274.2017.09.003]
9 Hallet J,Law CH,Cukier M,Saskin R,Liu N,Singh S.Exploring the rising incidence of neuroendocrine tumors:a population-based analysis of epidemiology,metastatic presentation,and outcomes.Cancer 2015;121:589-597[PMID:25312765 DOI:10.1002/cncr.29099]
10 O’Connor JM,Marmissolle F,Bestani C,Pesce V,Belli S,Dominichini E,Mendez G,Price P,Giacomi N,Pairola A,Loria FS,Huertas E,Martin C,Patane K,Poleri C,Rosenberg M,Cabanne A,Kujaruk M,Caino A,Zamora V,Mariani J,Dioca M,Parma P,Podesta G,Andriani O,Gondolesi G,Roca E.Observational study of patients with gastroenteropancreatic and bronchial neuroendocrine tumors in Argentina:Results from the large database of a multidisciplinary group clinical multicenter study.Mol Clin Oncol 2014;2:673-684[PMID:25054030 DOI:10.3892/mco.2014.332]
11 Lawrence B,Gustafsson BI,Chan A,Svejda B,Kidd M,Modlin IM.The epidemiology of gastroenteropancreatic neuroendocrine tumors.Endocrinol Metab Clin North Am 2011;40:1-18,vii[PMID:21349409 DOI:10.1016/j.ecl.2010.12.005]
12邱旭东,刘猛,刘青,杨志英,刘继喜,孟凡强,王在勇,史艳芬,刘立国,张盼,罗杰,谭煌英.903例神经内分泌肿瘤发病部位与病理特征分析.中华胃肠外科杂志2017;20:993-996[DOI:10.3760/cma.j.issn.1671-0274.2017.09.008]
13 Zhang M,Zhao P,Shi X,Zhao A,Zhang L,Zhou L.Clinicopathological features and prognosis of gastroenteropancreatic neuroendocrine neoplasms in a Chinese population:a large,retrospective single-centre study.BMC Endocr Disord 2017;17:39[PMID:28705205 DOI:10.1186/s12902-017-0190-6]
14张盼,张雨,张驰,史艳芬,刘继喜,刘青,于莉莉,王淼,邹国铭,罗杰,陈洁,谭煌英.241例胃神经内分泌肿瘤的临床分型及其特点.中华胃肠外科杂志2016;19:1241-1246[DOI:10.3760/cma.j.issn.1671-0274.2016.11.009]
15梁文全,高云鹤,李佶阳,崔建新,郗洪庆,蔡爱珍,陈凛.104例胃神经内分泌肿瘤的临床病理特征及预后分析.中华胃肠外科杂志2016;19:427-431[DOI:10.3760/cma.j.issn.1671-0274.2016.04.017]
2 Yao JC,Hassan M,Phan A,Dagohoy C,Leary C,Mares JE,Abdalla EK,Fleming JB,Vauthey JN,Rashid A,Evans DB.One hundred years after"carcinoid":epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States.J Clin Oncol 2008;26:3063-3072[PMID:18565894 DOI:10.1200/JCO.2007.15.4377]
3 Modlin IM,Lye KD,Kidd M.A 5-decade analysis of 13,715carcinoid tumors.Cancer 2003;97:934-959[PMID:12569593DOI:10.1002/cncr.11105]
4 Niederle MB,Hackl M,Kaserer K,Niederle B.Gastroenteropancreatic neuroendocrine tumours:the current incidence and staging based on the WHO and European Neuroendocrine Tumour Society classification:an analysis based on prospectively collected parameters.Endocr Relat Cancer 2010;17:909-918[PMID:20702725 DOI:10.1677/ERC-10-0152]
5谭煌英,娄彦妮,罗杰,刘继喜,贾立群.胃神经内分泌肿瘤的分型诊断和治疗.中国医学前沿杂志(电子版)2014;11:4-8[DOI:10.3969/j.issn.1674-7372.2014.11.003]
6 Bosman FT,Carneiro F,Hruban RH,Theise ND.WHOclassification of tumours of the digestive system.4th ed.Lyon:IARC press;2010:13-14
7 2013年中国胃肠胰神经内分泌肿瘤病理诊断共识专家组.中国胃肠胰神经内分泌肿瘤病理诊断共识(2013版).中华病理学杂志2013;42:691-694[DOI:10.3760/cma.j.issn.0529-5807.2013.10.011]
8陈洛海,周志伟,陈洁.美国癌症联合委员会(AJCC)第8版胃肠胰神经内分泌肿瘤分期解读及评价.中华胃肠外科杂志2017;20:972-976[DOI:10.3760/cma.j.issn.1671-0274.2017.09.003]
9 Hallet J,Law CH,Cukier M,Saskin R,Liu N,Singh S.Exploring the rising incidence of neuroendocrine tumors:a population-based analysis of epidemiology,metastatic presentation,and outcomes.Cancer 2015;121:589-597[PMID:25312765 DOI:10.1002/cncr.29099]
10 O’Connor JM,Marmissolle F,Bestani C,Pesce V,Belli S,Dominichini E,Mendez G,Price P,Giacomi N,Pairola A,Loria FS,Huertas E,Martin C,Patane K,Poleri C,Rosenberg M,Cabanne A,Kujaruk M,Caino A,Zamora V,Mariani J,Dioca M,Parma P,Podesta G,Andriani O,Gondolesi G,Roca E.Observational study of patients with gastroenteropancreatic and bronchial neuroendocrine tumors in Argentina:Results from the large database of a multidisciplinary group clinical multicenter study.Mol Clin Oncol 2014;2:673-684[PMID:25054030 DOI:10.3892/mco.2014.332]
11 Lawrence B,Gustafsson BI,Chan A,Svejda B,Kidd M,Modlin IM.The epidemiology of gastroenteropancreatic neuroendocrine tumors.Endocrinol Metab Clin North Am 2011;40:1-18,vii[PMID:21349409 DOI:10.1016/j.ecl.2010.12.005]
12邱旭东,刘猛,刘青,杨志英,刘继喜,孟凡强,王在勇,史艳芬,刘立国,张盼,罗杰,谭煌英.903例神经内分泌肿瘤发病部位与病理特征分析.中华胃肠外科杂志2017;20:993-996[DOI:10.3760/cma.j.issn.1671-0274.2017.09.008]
13 Zhang M,Zhao P,Shi X,Zhao A,Zhang L,Zhou L.Clinicopathological features and prognosis of gastroenteropancreatic neuroendocrine neoplasms in a Chinese population:a large,retrospective single-centre study.BMC Endocr Disord 2017;17:39[PMID:28705205 DOI:10.1186/s12902-017-0190-6]
14张盼,张雨,张驰,史艳芬,刘继喜,刘青,于莉莉,王淼,邹国铭,罗杰,陈洁,谭煌英.241例胃神经内分泌肿瘤的临床分型及其特点.中华胃肠外科杂志2016;19:1241-1246[DOI:10.3760/cma.j.issn.1671-0274.2016.11.009]
15梁文全,高云鹤,李佶阳,崔建新,郗洪庆,蔡爱珍,陈凛.104例胃神经内分泌肿瘤的临床病理特征及预后分析.中华胃肠外科杂志2016;19:427-431[DOI:10.3760/cma.j.issn.1671-0274.2016.04.017]