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目的探讨大连地区直肠神经内分泌肿瘤患者的临床病理特征和预后。方法回顾性分析2004年1月至2013年12月间大连地区确诊的99例直肠神经内分泌肿瘤患者的临床病理和生存资料,生存分析采用Cox比例风险模型计算风险比值和95%可信区间。结果诊断直肠神经内分泌肿瘤常用的辅助检查有直肠镜、超声、CT和MRI,其阳性诊断率分别为100.0%、58.6%、49.5%和70.6%。常用的免疫组化指标有嗜铬蛋白A、突触囊泡蛋白和神经元特异性烯醇化酶,其阳性诊断率分别为74.7%、76.2%和32.7%。主要临床表现为便血的患者为36例(36.4%),为腹痛的患者22例(22.2%)。肿瘤平均直径为(7.2±3.2)cm,肿瘤直径以>2cm为主,占全部的75.8%。患者平均生存时间为(9.4±0.2)年,生存分析发现肿瘤直径是影响预后的独立因素,差异有统计学意义(P=0.03)。结论直肠神经内分泌肿瘤以非功能性神经内分泌肿瘤居多,且无典型临床症状和体征,原发肿瘤直径将影响患者预后。
Objective To investigate the clinicopathological features and prognosis of patients with rectal neuroendocrine tumors in Dalian. METHODS: The clinical pathology and survival data of 99 patients with rectal neuroendocrine tumors diagnosed from January 2004 to December 2013 in Dalian were retrospectively analyzed. The Cox proportional hazards model was used for survival analysis to calculate the risk ratio and 95% confidence interval. Results The commonly used auxiliary examinations for diagnosis of rectal neuroendocrine tumors included proctoscopy, ultrasound, CT and MRI. The positive diagnostic rates were 100.0%, 58.6%, 49.5% and 70.6%, respectively. Commonly used immunohistochemical markers are pheochromocytoxin A, synaptophysin, and neuron-specific enolase, with positive diagnostic rates of 74.7%, 76.2%, and 32.7%, respectively. The main clinical manifestations were 36 cases (36.4%) of patients with blood in the stool and 22 cases (22.2%) of patients with abdominal pain. The average tumor diameter was (7.2±3.2) cm, and the tumor diameter was mainly >2 cm, accounting for 75.8% of all tumors. The average survival time was (9.4±0.2) years. The survival analysis revealed that the tumor diameter was an independent factor that affected the prognosis. The difference was statistically significant (P=0.03). Conclusions Rectal neuroendocrine tumors are mostly non-functional neuroendocrine tumors, and there are no typical clinical symptoms and signs. The diameter of the primary tumor will affect the prognosis of patients.