摘要
目的探讨结直肠高级别混合性腺神经内分泌癌(mixed adenoneuroendocrine carcinoma,MANEC)和神经内分泌癌(neuroendocrine carcinoma,NEC)的临床病理特征和预后。方法回顾性分析结直肠高级别MANEC(10例)及NEC(16例)的临床病理资料。采用免疫组织化学法检测神经内分泌标志物及转录因子。通过生存分析比较两组患者的生存率,对影响预后相关因素进行Cox回归分析。结果结直肠高级别MANEC和NEC患者发病部位差异具有统计学意义(P=0.014)。10例高级别MANEC中,7例发生淋巴结转移,其中71.4%的转移淋巴结内是神经内分泌癌成分,29.6%的转移淋巴结内是腺癌成分。16例NEC中,11例发生淋巴结转移,转移淋巴结内都是神经内分泌癌成分。高级别MANEC和NEC患者累积生存率比较差异无统计学意义(1年生存率80.0%vs75.0%,3年生存率17.1%vs 41.7%,P=0.275)。多因素分析结果显示,淋巴结转移是预后的独立影响因素(P=0.036)。结论结直肠高级别MANEC和NEC中的神经内分泌癌成分容易发生淋巴结转移,主导疾病进程。
Objective To investigate the clinicopathological features and prognosis of colorectal high-grade mixed adenoneuroendocrine carcinoma( MANEC) and neuroendocrine carcinoma( NEC). Methods The clinicopathological data of 10 cases of colorectal high-grade MANEC and 16 cases of NEC were retrospectively analyzed. The expression of neuroendocrine markers and transcription factors was detected by immunohistochemistry. The survival rates of the two groups were compared by the Kaplan-Meier survival analysis,and the prognostic factors were analyzed by Cox proportional regression model. Results The tumor location was significantly different between the two groups( P = 0. 014). In the 10 cases of high-grade MANEC,7 cases showed lymph node metastasis,among which 71. 4% of the metastatic cancer tissue were neuroendocrine carcinoma originated and 29. 6% were adenocarcinoma originated. In the 16 cases of NEC,lymph node metastasis was found in 11 cases,and all contained neuroendocrine carcinoma components. No significant cumulative survival difference was observed between the high-grade MANEC and the NEC group( 1-year survival rate: 80. 0% vs 75. 0%,3-year survival rate: 17. 1% vs 41. 7%,P = 0. 275). Lymph node metastasis was suggested to be an independent risk factor of disease prognosis by multivariable analysis( P = 0. 036). Conclusion The neuroendocrine carcinoma component of colorectal high-grade MANEC and NEC is prone to develop lymph node metastasis and has a major impact on the disease process.
引文
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