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目的:探讨胃肠道神经内分泌肿瘤的临床病理特征及其预后。方法:回顾性分析我院普外科2008年1月至2014年7月期间收治的56例神经内分泌肿瘤患者的临床病理资料。结果:本研究共纳入56例神经内分泌肿瘤患者,男35例,女21例;平均年龄(47.2±11.2)岁。所有患者住院时间为(15.4±6.2)d,平均肿瘤直径为(3.8±1.2)cm。肿瘤好发于直肠,共25例(44.6%),其次是胃17例(30.4%),结肠9例(16.1%),小肠5例(8.9%)。32例患者(57.1%)表现为腹痛或腹部不适,16例表现为黑便或便血,2例表现为典型的类癌综合征,另6例患者因体检、腹部包块而发现。根据WHO 2010年新分类标准,神经内分泌瘤(NET)共42例,13例为神经内分泌癌(NEC),1例为混合性腺神经内分泌癌(MANEC)。NET肿瘤直径较NEC更小(P<0.001);术后NEC肿瘤复发或远处转移率较NET更高(P=0.014)。术后中位随访时间38个月(范围1~80个月),全组1、3年无进展生存率分别为98.2%和91.1%;1、3年总体生存率为96.4%和87.5%。结论:胃肠道神经内分泌肿瘤好发于直肠,NEC恶性程度高,易复发或发生远处转移,较NET预后更差。
Objective: To investigate the clinicopathological features and prognosis of gastrointestinal neuroendocrine tumors. Methods: Retrospectively analyzed the clinical and pathological data of 56 patients with neuroendocrine tumors admitted to our department from January 2008 to July 2014. Results: A total of 56 patients with neuroendocrine tumors were enrolled in this study, 35 males and 21 females; the mean age was (47.2±11.2) years. The length of hospital stay was (15.4 ± 6.2) days for all patients, and the average tumor diameter was (3.8 ± 1.2) cm. Tumors occurred in the rectum with a total of 25 cases (44.6%), followed by 17 cases (30.4%) in the stomach, 9 cases (16.1%) in the colon, and 5 cases (8.9%) in the small intestine. 32 patients (57.1%) showed abdominal pain or abdominal discomfort, 16 showed melena or blood in the stool, 2 showed typical carcinoid syndrome, and the other 6 patients were found by physical examination and abdominal mass. According to the WHO 2010 new classification criteria, there are 42 neuroendocrine tumors (NET), 13 neuroendocrine carcinomas (NEC) and 1 mixed glandular neuroendocrine carcinoma (MANEC). NET tumor size was smaller than NEC (P<0.001); postoperative NEC tumor recurrence or distant metastasis was higher than NET (P=0.014). After a median follow-up of 38 months (range, 1 to 80 months), the progression-free survival rate of the whole group was 19.9 years and 91.1%, respectively. The 1-year and 3-year overall survival rates were 96.4% and 87.5%. Conclusion: Gastrointestinal neuroendocrine tumors occur in the rectum. NEC has a high degree of malignancy, is susceptible to recurrence or distant metastasis, and has a worse prognosis than NET.