目的 探讨不同病理分级的直肠神经内分泌肿瘤的临床特征与预后情况.方法 回顾性分析2001年1月至2012年4月解放军总医院确诊的183例直肠神经内分泌肿瘤患者的临床资料.从医生工作站及内镜中心数据库中,检索经内镜治疗和(或)外科手术治疗的直肠神经内分泌肿瘤患者的临床及病理资料.按照2010年WHO消化系统肿瘤分类标准,依核分裂象数对病理检查结果进行分级.通过返院复查及电话随访了解患者预后情况.以患者死亡或2014年7月为随访终点.多样本间率的比较采用双向无序卡方检验.结果 183例患者纳入研究.其中男120例,女63例,男女比例为1.9∶1.年龄为14 ～ 83岁,平均年龄为48岁.临床症状:便血者74例,健康体检无意发现者70例,腹痛及大便习惯改变者各9例,其他的临床表现有肿瘤标志物升高、腹胀或合并多种症状等,无一例表现为类癌综合征.183例患者中,同时伴发肠道息肉14例,合并管状腺瘤5例,合并结直肠腺癌3例,合并小细胞肺癌1例.肿瘤直径＜1 cm 162例,1～2 cm14例,＞2 cm7例.肿瘤距肛门距离为(5±3)cm.183例患者中,130例行内镜治疗,43例行外科治疗,10例误诊小息肉行钳除,未行进一步治疗.183例患者中,G1级158例(TNM Ⅰ期154例、Ⅱ期1例、Ⅲ期1例、Ⅳ期2例);G2级21例(TNM Ⅰ期13例、Ⅱ期3例、Ⅲ期3例、Ⅳ期2例);G3级4例(TNM Ⅰ期1例、Ⅲ期1例、Ⅳ期2例).183例患者中,有6例发生肝转移,9例发生淋巴结转移,14例患者死亡(G1级4例、G2级6例、G3级4例),5年生存率为92.35％(169/183).不同分级直肠神经内分泌肿瘤患者在肿瘤直径、肿瘤分期、肝转移、淋巴结转移、5年生存情况等方面比较,差异有统计学意义(x2=60.949,71.587,32.135,55.486,56.512,P＜0.05).结论 直肠神经内分泌肿瘤缺乏特异性临床表现,男性好发,部位多位于直肠中下段,多数肿瘤直径＜1 cm,多数患者为TNM Ⅰ期,G1级.不同分级的直肠神经内分泌肿瘤预后不同,按照2010年WHO消化系统肿瘤分类标准进行分级对预后有参考价值,制订治疗方案时应考虑分级的因素.
目的 探討不同病理分級的直腸神經內分泌腫瘤的臨床特徵與預後情況.方法 迴顧性分析2001年1月至2012年4月解放軍總醫院確診的183例直腸神經內分泌腫瘤患者的臨床資料.從醫生工作站及內鏡中心數據庫中,檢索經內鏡治療和(或)外科手術治療的直腸神經內分泌腫瘤患者的臨床及病理資料.按照2010年WHO消化繫統腫瘤分類標準,依覈分裂象數對病理檢查結果進行分級.通過返院複查及電話隨訪瞭解患者預後情況.以患者死亡或2014年7月為隨訪終點.多樣本間率的比較採用雙嚮無序卡方檢驗.結果 183例患者納入研究.其中男120例,女63例,男女比例為1.9∶1.年齡為14 ～ 83歲,平均年齡為48歲.臨床癥狀:便血者74例,健康體檢無意髮現者70例,腹痛及大便習慣改變者各9例,其他的臨床錶現有腫瘤標誌物升高、腹脹或閤併多種癥狀等,無一例錶現為類癌綜閤徵.183例患者中,同時伴髮腸道息肉14例,閤併管狀腺瘤5例,閤併結直腸腺癌3例,閤併小細胞肺癌1例.腫瘤直徑＜1 cm 162例,1～2 cm14例,＞2 cm7例.腫瘤距肛門距離為(5±3)cm.183例患者中,130例行內鏡治療,43例行外科治療,10例誤診小息肉行鉗除,未行進一步治療.183例患者中,G1級158例(TNM Ⅰ期154例、Ⅱ期1例、Ⅲ期1例、Ⅳ期2例);G2級21例(TNM Ⅰ期13例、Ⅱ期3例、Ⅲ期3例、Ⅳ期2例);G3級4例(TNM Ⅰ期1例、Ⅲ期1例、Ⅳ期2例).183例患者中,有6例髮生肝轉移,9例髮生淋巴結轉移,14例患者死亡(G1級4例、G2級6例、G3級4例),5年生存率為92.35％(169/183).不同分級直腸神經內分泌腫瘤患者在腫瘤直徑、腫瘤分期、肝轉移、淋巴結轉移、5年生存情況等方麵比較,差異有統計學意義(x2=60.949,71.587,32.135,55.486,56.512,P＜0.05).結論 直腸神經內分泌腫瘤缺乏特異性臨床錶現,男性好髮,部位多位于直腸中下段,多數腫瘤直徑＜1 cm,多數患者為TNM Ⅰ期,G1級.不同分級的直腸神經內分泌腫瘤預後不同,按照2010年WHO消化繫統腫瘤分類標準進行分級對預後有參攷價值,製訂治療方案時應攷慮分級的因素.
목적 탐토불동병리분급적직장신경내분비종류적림상특정여예후정황.방법 회고성분석2001년1월지2012년4월해방군총의원학진적183례직장신경내분비종류환자적림상자료.종의생공작참급내경중심수거고중,검색경내경치료화(혹)외과수술치료적직장신경내분비종류환자적림상급병리자료.안조2010년WHO소화계통종류분류표준,의핵분렬상수대병리검사결과진행분급.통과반원복사급전화수방료해환자예후정황.이환자사망혹2014년7월위수방종점.다양본간솔적비교채용쌍향무서잡방검험.결과 183례환자납입연구.기중남120례,녀63례,남녀비례위1.9∶1.년령위14 ～ 83세,평균년령위48세.림상증상:편혈자74례,건강체검무의발현자70례,복통급대편습관개변자각9례,기타적림상표현유종류표지물승고、복창혹합병다충증상등,무일례표현위유암종합정.183례환자중,동시반발장도식육14례,합병관상선류5례,합병결직장선암3례,합병소세포폐암1례.종류직경＜1 cm 162례,1～2 cm14례,＞2 cm7례.종류거항문거리위(5±3)cm.183례환자중,130례행내경치료,43례행외과치료,10례오진소식육행겸제,미행진일보치료.183례환자중,G1급158례(TNM Ⅰ기154례、Ⅱ기1례、Ⅲ기1례、Ⅳ기2례);G2급21례(TNM Ⅰ기13례、Ⅱ기3례、Ⅲ기3례、Ⅳ기2례);G3급4례(TNM Ⅰ기1례、Ⅲ기1례、Ⅳ기2례).183례환자중,유6례발생간전이,9례발생림파결전이,14례환자사망(G1급4례、G2급6례、G3급4례),5년생존솔위92.35％(169/183).불동분급직장신경내분비종류환자재종류직경、종류분기、간전이、림파결전이、5년생존정황등방면비교,차이유통계학의의(x2=60.949,71.587,32.135,55.486,56.512,P＜0.05).결론 직장신경내분비종류결핍특이성림상표현,남성호발,부위다위우직장중하단,다수종류직경＜1 cm,다수환자위TNM Ⅰ기,G1급.불동분급적직장신경내분비종류예후불동,안조2010년WHO소화계통종류분류표준진행분급대예후유삼고개치,제정치료방안시응고필분급적인소.
Objective To investigate the clinical features and prognosis of rectal neuroendocrine neoplasms (NENs) in different pathological grades.Methods The clinical data of 183 patients with rectal NENs who were admitted to the PLA General Hospital from January 2001 to April 2012 were retrospectively analyzed.All the clinical and pathological data of the patients who received endoscopy and (or) surgical resection were retrieved from the work station and the database of the endoscopic center.Based on the 2010 WHO pathology classification of digestive tumors,the pathological data were ranked according to the mitotic count.The prognosis of the patients was learned by re-examination or phone call.The follow-up ended till July 2014 or at the death of patients.Data were analyzed using the chi-square test.Results A total of 183 patients were enrolled in this study including 120 males and 63 females.The median age of the patients was 48 years (range,14-83 years).Seventy-four patients had the symptom of hemafecia,9 patients had abdominal pain and change in bowel habit,and 70 patients were diagnosed by body examination.Other symptoms included increased level of tumor markers and abdominal distension.Carcinoid syndrome was not detected in all the patients.Fourteen patients were complicated with polyp of intestine,5 with tubular adenoma,3 with colorectal adenocarcinoma and 1 with small cell lung cancer.The diameters of the tumor under 1 cm were detected in 162 patients,the diameters of the tumors ranged between 1 cm and 2 cm in 14 patients,and the diameters of the tumors above 2 cm in 7 patients.The mean distance between the tumor and the anus was (5-± 3)cm.Of the 183 patients,130 received endoscopic treatment,43 received surgical treatment and 10 received clamping because the tumor was misdiagnosed as polyps.There were 158 patients in grade1 (154 in stage Ⅰ,1 in stage Ⅱ,1 in stage Ⅲ and 2 in stage Ⅳ),21 in grade2 (13 in stage Ⅰ,3in stage Ⅱ,3 in stage Ⅲ and 2 in stage Ⅳ),4 in grade 3 (1 in stage Ⅰ,1 in stage Ⅲ and 2 in stage Ⅳ).Six patients had liver metastasis and 9 had lymph node metastasis.Fourteen patients died (4 in grade 1,6 in grade 2 and 4 in grade 3).The 5-year survival rate of patients was 92.35％ (169/183).There were significant differences in the gender,tumor diameter,tumor staging,lymph node metastasis distal metastasis and 5-year survival rate among patients with rectal NENs in different pathological grades (x2=60.949,71.587,32.135,55.486,56.512,P ＜ 0.05).Conclusions Rectal NENs lacks the specific clinical manifestation and is more likely to happen in males,and it often locates at the middle-lower rectum.Most of the rectal NENs belongs to stage Ⅰ and grade 1 and is less than 1 cm in size.The prognosis of patients with rectal NENs in different pathological grades is different.The 2010 WHO pathology classification of digestive tumors is useful to asses the prognosis of rectal NENs.Different grades of rectal NENs could be taken into account when designing the treatment plan.
