中国实用外科杂志

中国实用外科杂志

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胃神经内分泌肿瘤96例临床病理特征及预后分析

张    鹏，李承果，贾    杰，陈    鑫，孙    雄，童    昕，刘炜圳，王    征，王国斌，陶凯雄   

  1. 华中科技大学医学院附属协和医院胃肠外科，湖北武汉  430022
  • 发布日期:2020-07-23

  • Published:2020-07-23

摘要： 目的    探讨胃神经内分泌肿瘤（g-NENs）的临床病理特征及预后影响因素。方法    回顾性分析2010年3月至2019年6月华中科技大学同济医学院附属协和医院胃肠外科收治的96例原发g-NENs病人的临床资料。根据2010年版WHO消化系统肿瘤分类标准对g-NENs进行病理学分类。采用Kaplan-Meier法绘制生存曲线并计算存活率，Log-rank检验进行单因素生存分析，Cox比例风险回归模型进行多因素分析。结果    96例病人中83例行手术治疗，其中80例行完整切除手术，3例行姑息手术。随访42（2~84）个月，行完整切除手术病人预后优于未行完整切除手术者，差异有统计学意义（P<0.001）。80例行完整切除手术病人中，G1级胃神经内分泌瘤（g-NET）8例，G2级g-NET 6例，胃神经内分泌癌（g-NEC）43例，胃混合性腺神经内分泌癌（g-MANEC）23例。g-NET病人预后优于g-NEC（P=0.009）和g-MANEC（P=0.035），而g-NEC与g-MANEC病人预后差异无统计学意义（P=0.551）。对66例g-NEC和g-MANEC病例进行单因素生存分析显示，TNM分期、中性粒细胞-淋巴细胞比值（NLR）以及预后营养指数（PNI）是影响病人总体生存时间（OS）的危险因素；多因素分析显示，TNM分期Ⅲ/Ⅳ期（HR=8.411，95%CI 1.140~62.052，P=0.037）与NLR>1.93（HR=4.011，95%CI 1.386~11.612，P=0.010）是影响OS的独立危险因素。结论 g-NET病人预后优于g-NEC和g-MANEC，而g-NEC与g-MANEC病人预后差异无统计学意义。TNM分期Ⅲ/Ⅳ期、术前NLR>1.93的g-NEC和g-MANEC病人的预后相对较差。

关键词: 神经内分泌肿瘤, 胃, 临床病理特征, 中性粒细胞-淋巴细胞比值, 预后

Abstract: Clinicopathological features and prognosis of patients with gastric neuroendocrine neoplasms: An analysis of 96 cases        ZHANG Peng，LI Cheng-guo，JIA Jie，et al. Department of Gastrointestinal Surgery，Union Hospital，Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430022，China
Corresponding author：TAO Kai-xiong，E-mail: kaixiongtao@hust.edu.cn
Abstract    Objective    To investigate the clinicopathological features and prognostic factors of gastric neuroendocrine neoplasms (g-NENs). Methods    The clinicopathological data of 96 patients with primary g-NENs admitted in Union Hospital，Tongji Medical College，Huazhong University of Science and Technology from March 2010 to June 2019 were analyzed retrospectively. Patients were classified pathologically according to WHO Classification of Tumours of the Digestive System 2010 edition. Kaplan-Meier method was used to draw survival curve and calculate overall survival rate (OS). Log-rank test was conducted for univariate survival analysis，Cox proportional hazards regression model for multivariate survival analysis. Results    Of the 96 g-NENs patients，83 patients underwent surgical treatment，of which 80 cases underwent complete resection and 3 cases underwent palliative surgery. The median follow-up time of 96 patients was 42 (2-84) months，and the prognosis of patients with complete resection was significantly better than that of patients without radical surgery (P<0.001). Among the 80 patients who underwent complete resection，8 cases were G1 gastric neuroendocrine tumor (g-NET)，6 cases were G2 g-NET，43 cases were gastric neuroendocrine carcinoma (g-NEC)，and 23 cases were gastric mixed adenoneuroendocrine carcinoma (g-MANEC). The prognosis of g-NET was significantly better than that of g-NEC (P=0.009) and g-MANEC (P=0.035)，but there was no significant difference between g-NEC and g-MANEC (P=0.551). Univariate analysis of the 66 cases of g-NEC and g-MANEC showed that TNM stage，preoperative neutrophil-to-lymphocyte ratio (NLR) and prognostic nutrition index (PNI) were statistically significant. Multivariate analysis showed that TNM stage Ⅲ/Ⅳ (HR=8.411，95%CI 1.140-62.052，P=0.037) and NLR>1.93 (HR=4.011，95%CI 1.386-11.612，P=0.010) were independent prognostic factors of OS in g-NEC and g-MANEC patients. Conclusion    The prognosis of g-NET is better than that of g-NEC and g-MANEC，while the prognosis of g-NEC and g-MANEC is not significantly different. TNM stage Ⅲ/Ⅳ and preoperative NLR>1.93 were associated with poor prognosis of patients with g-NEC and g-MANEC.

Key words: neuroendocrine neoplasm, stomach, clinicopathological feature, neutrophil-to-lymphocyte ratio, prognosis