中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2012年
6期
450-456
,共7页
高巍%刘尚梅%鲁海珍%梁晶%袁燕玲%刘秀云
高巍%劉尚梅%魯海珍%樑晶%袁燕玲%劉秀雲
고외%류상매%로해진%량정%원연령%류수운
肠肿瘤%神经内分泌肿瘤%病理学,临床%预后
腸腫瘤%神經內分泌腫瘤%病理學,臨床%預後
장종류%신경내분비종류%병이학,림상%예후
Intestinal neoplasms%Neuroendocrine neoplasms%Pathology,clinical%Prognosis
目的 探讨肠道不同组织学类型神经内分泌肿瘤的临床病理特点和预后.方法 回顾性分析114例肠道神经内分泌肿瘤患者的临床病理和随访资料,其中神经内分泌瘤1级(G1级)89例,神经内分泌瘤2级(G2级)13例,神经内分泌癌(G3级)10例(包括小细胞癌3例,分化差的神经内分泌癌7例),混合型腺-神经内分泌癌( MANEC)2例.以SP法对所有标本进行相关免疫组化标志物染色.结果 肠道神经内分泌肿瘤的男女发病比例为1.33∶1,肿瘤多位于直肠,以息肉样隆起型肿物为主.免疫组化染色结果显示,CgA、Syn、CD56、NSE、CD57、S100、PGP9.5、AE1/AE3、CK8、CDX2和CEA的阳性率分别为43.0％、97.4％、75.4％、95.6％、72.8％、36.0％、84.2％、91.2％、98.2％、32.5％和31.6％.Syn和CgA联合检测的阳性率为99.1％,Syn、CgA与CD56、CD57以及PGP9.5任一项联合检测的阳性率为100％.全组患者的5年总生存率为92.9％.G1级患者的5年生存率为98.9％；G2级患者的5年生存率为76.9％；7例分化差的神经内分泌癌中有2例分别于术后12和78个月死亡,2例失访,3例分别随访4、8和10个月,至今无瘤生存；3例小细胞癌中有2例分别于术后8和24个月死亡,1例失访；2例MANEC术后分别随访84和60个月,至今无瘤生存.不同组织学类型肠道神经内分泌肿瘤患者的性别比例、原发部位、大体类型、肿瘤大小、合并肿瘤类型、pT分期、血管神经侵犯情况、淋巴结和远处转移情况以及生存情况的差异均有统计学意义(均P ＜0.05).单因素分析的结果显示,肠道神经内分泌肿瘤的转移与肿瘤大小(Z=-6.334,P ＜0.001)、组织学类型(x2=31.175,P ＜0.001)和浸润深度(x2 =63.567,P＜0.001)有关.多因素Logistic回归分析的结果显示,肿瘤的浸润深度是影响肠道神经内分泌肿瘤发生转移的重要因素(OR=1.827,P＜0.05).结论 肠道神经内分泌肿瘤多发于男性,直肠最多见,以息肉样隆起型肿物为主.肿瘤的组织学分类与肠道神经内分泌肿瘤患者的预后有关,肿瘤的浸润深度是影响肠道神经内分泌肿瘤转移的重要因素.在特异性免疫组织化学标志物中,Syn与CgA联用诊断的敏感性较高.
目的 探討腸道不同組織學類型神經內分泌腫瘤的臨床病理特點和預後.方法 迴顧性分析114例腸道神經內分泌腫瘤患者的臨床病理和隨訪資料,其中神經內分泌瘤1級(G1級)89例,神經內分泌瘤2級(G2級)13例,神經內分泌癌(G3級)10例(包括小細胞癌3例,分化差的神經內分泌癌7例),混閤型腺-神經內分泌癌( MANEC)2例.以SP法對所有標本進行相關免疫組化標誌物染色.結果 腸道神經內分泌腫瘤的男女髮病比例為1.33∶1,腫瘤多位于直腸,以息肉樣隆起型腫物為主.免疫組化染色結果顯示,CgA、Syn、CD56、NSE、CD57、S100、PGP9.5、AE1/AE3、CK8、CDX2和CEA的暘性率分彆為43.0％、97.4％、75.4％、95.6％、72.8％、36.0％、84.2％、91.2％、98.2％、32.5％和31.6％.Syn和CgA聯閤檢測的暘性率為99.1％,Syn、CgA與CD56、CD57以及PGP9.5任一項聯閤檢測的暘性率為100％.全組患者的5年總生存率為92.9％.G1級患者的5年生存率為98.9％；G2級患者的5年生存率為76.9％；7例分化差的神經內分泌癌中有2例分彆于術後12和78箇月死亡,2例失訪,3例分彆隨訪4、8和10箇月,至今無瘤生存；3例小細胞癌中有2例分彆于術後8和24箇月死亡,1例失訪；2例MANEC術後分彆隨訪84和60箇月,至今無瘤生存.不同組織學類型腸道神經內分泌腫瘤患者的性彆比例、原髮部位、大體類型、腫瘤大小、閤併腫瘤類型、pT分期、血管神經侵犯情況、淋巴結和遠處轉移情況以及生存情況的差異均有統計學意義(均P ＜0.05).單因素分析的結果顯示,腸道神經內分泌腫瘤的轉移與腫瘤大小(Z=-6.334,P ＜0.001)、組織學類型(x2=31.175,P ＜0.001)和浸潤深度(x2 =63.567,P＜0.001)有關.多因素Logistic迴歸分析的結果顯示,腫瘤的浸潤深度是影響腸道神經內分泌腫瘤髮生轉移的重要因素(OR=1.827,P＜0.05).結論 腸道神經內分泌腫瘤多髮于男性,直腸最多見,以息肉樣隆起型腫物為主.腫瘤的組織學分類與腸道神經內分泌腫瘤患者的預後有關,腫瘤的浸潤深度是影響腸道神經內分泌腫瘤轉移的重要因素.在特異性免疫組織化學標誌物中,Syn與CgA聯用診斷的敏感性較高.
목적 탐토장도불동조직학류형신경내분비종류적림상병리특점화예후.방법 회고성분석114례장도신경내분비종류환자적림상병리화수방자료,기중신경내분비류1급(G1급)89례,신경내분비류2급(G2급)13례,신경내분비암(G3급)10례(포괄소세포암3례,분화차적신경내분비암7례),혼합형선-신경내분비암( MANEC)2례.이SP법대소유표본진행상관면역조화표지물염색.결과 장도신경내분비종류적남녀발병비례위1.33∶1,종류다위우직장,이식육양륭기형종물위주.면역조화염색결과현시,CgA、Syn、CD56、NSE、CD57、S100、PGP9.5、AE1/AE3、CK8、CDX2화CEA적양성솔분별위43.0％、97.4％、75.4％、95.6％、72.8％、36.0％、84.2％、91.2％、98.2％、32.5％화31.6％.Syn화CgA연합검측적양성솔위99.1％,Syn、CgA여CD56、CD57이급PGP9.5임일항연합검측적양성솔위100％.전조환자적5년총생존솔위92.9％.G1급환자적5년생존솔위98.9％；G2급환자적5년생존솔위76.9％；7례분화차적신경내분비암중유2례분별우술후12화78개월사망,2례실방,3례분별수방4、8화10개월,지금무류생존；3례소세포암중유2례분별우술후8화24개월사망,1례실방；2례MANEC술후분별수방84화60개월,지금무류생존.불동조직학류형장도신경내분비종류환자적성별비례、원발부위、대체류형、종류대소、합병종류류형、pT분기、혈관신경침범정황、림파결화원처전이정황이급생존정황적차이균유통계학의의(균P ＜0.05).단인소분석적결과현시,장도신경내분비종류적전이여종류대소(Z=-6.334,P ＜0.001)、조직학류형(x2=31.175,P ＜0.001)화침윤심도(x2 =63.567,P＜0.001)유관.다인소Logistic회귀분석적결과현시,종류적침윤심도시영향장도신경내분비종류발생전이적중요인소(OR=1.827,P＜0.05).결론 장도신경내분비종류다발우남성,직장최다견,이식육양륭기형종물위주.종류적조직학분류여장도신경내분비종류환자적예후유관,종류적침윤심도시영향장도신경내분비종류전이적중요인소.재특이성면역조직화학표지물중,Syn여CgA련용진단적민감성교고.
Objective To analyze the clinicopathological features of intestinal neuroendocrine neoplasms.Methods The clinicopathological features of 114 patients with intestinal neuroendocrine neoplasms treated in our hospital from April 1999 to March 2011 were retrospectively reviewed,including tumor location,histological classification,muscle invasion,metastasis and clinical data.Imnunohistochemical SP staining was applied to examine the expression of 15 markers in the tumor specimens.Results The male:female ratio of the patients was 1.33,and most of the tumors were located in the rectum of polypoid type.The positive rate of immunohistochemical staining of Syn expression was 97.4％,NSE 95.6％,PGP9.5 84.2％,CD56 75.4％,CD57 72.8％,CgA 43.0％,S100 36.0％,Syn combined with CgA 99.1％,and the two marker Syn and CgA combined with any one of CD56,CD57 or PGP9.5 reached to 100％.The 5-years survival rates of G1,G2 were 98.9％ and 76.9％,respectively,and the overall 5-year survival rate of intestinal neuroendocrine neoplasms was 92.9％.Two of the 7 cases of poor differentiated neuroendocrine carcinoma died after operation,another 2 of them lost to follow up.Others were still alive during the followup.Among the 3 patients with small cell carcinoma,two survived for 8 to 24 months after operation,and one lost to follow up.Two cases of mixed adenoneuroendocrine carcinoma (MANEC) were still surviving during the follow-up.Different histological types of intestinal neuroendocrine neoplasms were significantly different in sex,primary tumor site,pathological type,tumor size,types of combined tumors,pT stage,aggressive nervous and vascular invasion,and metastasis ( all P ＜ 0.05 ).Single factor analysis of the intestinal neuroendocrine neoplasms indicated that tumor size ( Z =- 6.334,P ＜ 0.001 ),histological classification (x2 =31.175,P ＜ 0.001 ) and muscle invasion (x2 =63.567,P ＜ 0.001 ) were associated with metastasis of intestinal neuroendocrine neoplasms.Logistic analysis showed that muscle invasion was the main behavior risk factor of this tumor ( OR =1.827,P ＜ 0.05).Conclusions Intestinal neuroendocrine neoplasm usually occur in males,and the most common involved organ is the rectum.Their histological types are related to the prognosis,and the depth of invasion is an important metastasis factor of intestinal neuroendocrine neoplasms.Of the neuroendocrine makers,the combination of CgA and Syn shows a higher diagnostic sensitivity.
