天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (1): 65-69.doi: 10.11958/20170918

• 临床研究 • 上一篇    下一篇

265 例神经内分泌肿瘤的临床病理特征及预后分析

宇永军 1，张诗武 2，李玉玮 1，许晨 1，张培达 1，张锡朋 1△   

  1. 1 天津市人民医院肛肠外科（邮编 300121），2 病理科
  • 收稿日期:2017-08-21 修回日期:2017-11-24 出版日期:2018-01-15 发布日期:2018-01-16
  • 通讯作者: 张锡朋 E-mail:125971854@qq.com
  • 作者简介:宇永军（1982），男，硕士，主要从事结直肠肿瘤及肛门良性疾病的研究

Clinicopathological features and risk factors of neuroendocrine tumors in 256 patients

YU Yong-jun1, ZHANG Shi-wu2, LI Yu-wei1, XU Chen1, ZHANG Pei-da1, ZHANG Xi-peng1△   

  1. 1 Department of Colorectal Surgery, 2 Department of Pathology, Tianjin Union Medicine Center, Tianjin 300121, China
  • Received:2017-08-21 Revised:2017-11-24 Published:2018-01-15 Online:2018-01-16

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摘要： 目的 探讨神经内分泌肿瘤（NETs）的发病特点、临床表现、诊断和治疗方法及预后。方法 回顾性分析 2006 年 1 月—2015 年 8 月天津市人民医院 265 例 NETs 患者的临床资料，包括性别、年龄、入院临床症状、原发部 位、病理诊断、治疗情况和预后随访情况。结果 265 例 NETs 患者中男 160 例，女 105 例，平均发病年龄（55.8±2.7） 岁，发病高峰 55~65 岁。发病部位主要位于结直肠 127 例（47.9%），肺部 59 例（22.3%），胃 21 例（7.8%），阑尾 15 例 （5.7%），小肠（特别是十二指肠及胰腺）10 例（3.8%），乳腺 11 例（4.2%），颈部 10 例（3.8%），其他部位 12 例（4.5%）。 各个不同部位患者的就诊症状各不相同。结直肠患者主要是排便习惯改变，如腹泻、便秘、便血等。肺原发患者多 表现为咳嗽或痰中带血。胃、阑尾或小肠原发患者多表现为腹痛、腹胀等不适。病理诊断 G1 期 186 例（70.2%），G2 期 54 例（20.4%），G3 期 25 例（9.4%）。免疫组化显示突触素（Syn）阳性 228 例（86.4%），嗜铬粒蛋白 A（CgA）阳性 102 例（38.5%），CD56 阳性 74 例（27.9%）。232 例患者进行了手术治疗（87.5%），28 例患者接受了放疗或化疗治疗 （10.6%），5 例患者未行治疗。198 例患者完成至少 1 次随访，随访率 74.7%，中位随访时间为 38 个月，G1 期随访患 者中无肿瘤相关性死亡；G2 期有 6 例肿瘤相关性死亡；G3 期中有 19 例肿瘤相关性死亡。所有肿瘤相关性死亡患者 中 23 例发生了转移。神经内分泌瘤（G1+G2）的生存率明显高于神经内分泌癌（G3）（Log rank χ2=13.774，P＜0.01）。 结论 NETs 患者男性多于女性，不同部位的患者发病临床表现各不相同，消化道特别是结直肠是高发部位；病理分 期越晚的患者预后越差。

关键词: 神经内分泌瘤, 临床表现, 病理学, 预后

Abstract: Objective To investigate the epidemiology, clinical manifestations, diagnosis, treatment and prognosis of neuroendocrine tumors (NETs). Methods Medical records of 265 patients with neuroendocrine tumors diagnosed and treated in our hospital from January 2006 to August 2015 were collected and retrospectively reviewed in this study. The clinicopathological data including gender, age of onset, initial symptoms, primary site, pathological conditions, diagnosis, treatment, prognosis and follow up were analyzed. Results The gender ratio M/F of the 265 cases was 160∶105 (1.5∶1), with mean age of (55.8±2.7) years, and the high incidence was in age of 55-65 years. The tumors were located in the colon and rectum (127 cases, 47.9%), lung (59 cases, 22.3%), stomach (21 cases, 7.8%), appendix (15 cases, 5.7%), small intestine (especially in the duodenum and pancreas, 10 cases, 3.8%), mammary gland (11 cases, 4.2%), neck (10 cases, 3.8％) and unknown primary site (12 cases, 4.5％ ). Patients with different tumor sites showed different symptoms. Patients with colorectal tumors mainly manifested as changes in bowel habits, such as diarrhea, constipation and blood in stool. The main manifestation of patients with primary pulmonary symptoms was cough or bloody sputum. The patients with tumors at stomach, appendix or small intestine showed many discomfort, such as abdominal pain and abdominal distention. Among the 265 cases, 186 patients were diagnosed as phase G1 (70.2%), 54 patients were diagnosed as phase G2 (20.4%) and 25 patients were diagnosed as phase G3 (9.4%). Immunohistochemistry showed that synaptophysin (Syn) was positive in 228 cases (86.4％), chromaffin A (CgA) was positive in 102 cases (38.5％), and C56 was positive in 74 cases (27.9％). A total of 232 patients were treated with surgery (87.5%), 28 patients received radiotherapy or chemotherapy treatment (10.6%) and 5 patients were not treated. One hundred and ninety-eight patients were followed up at least 1 time, and the follow-up rate was 74.7%. The median follow-up time was 38 months. No tumor related death was found in patients with phase G1 during the follow-up, 6 cases of tumor associated death were found in patients with phase G2 and 19 cases of cancer related death were found in patients with phase G3. Metastasis was found in all 23 patients with tumor related death. The survival rate of patients with neuroendocrine tumor (G1+G2) was significantly higher than that of patients with neuroendocrine carcinoma (G3, Log rank χ2=13.774，P＜0.01). Conclusion The males have a higher incidence rate of NETs than females. Patients with different tumor sites showed different symptoms. The most common primary sites of NETs are the digestive tract, especially in patients with colorectal cancer. The more late the pathological stage, the worse the prognosis.

Key words: neuroendocrine tumors, clinical manifestations, pathology, prognosis