神经内分泌肿瘤的诊治分析（附42例病例报告）

发布时间：2018-07-28 10:11

【摘要】：目的神经内分泌肿瘤(Neuroendocrine neoplasms)的患者早期临床表现通常不典型,诊断不明确。当肿瘤出现进展或表现出症状时,确诊不及时,治疗方法不合理,患者预后较差。根据我院神经内分泌肿瘤的诊治状况,讨论神经内分泌肿瘤的临床特点、检查项目、当前的治疗方案及预后生存因素。 方法收集并分析兰大一院在2011年1月至2013年6月底收治的42例神经内分泌肿瘤患者的临床资料、实验室病理检查和影像学资料,及给予的治疗方法。分析不同临床特征分组的患者生存情况(中位生存期和2年生存率),总结临床诊治经验,探讨影响该疾病预后的相关因素。 结果共收集42例神经内分泌肿瘤的病例,其中男性32例,女性10例,年龄从17岁至79岁,中位年龄59岁。胃肠道胰腺系统的神经内分泌肿瘤病例有20例,支气管肺系统的病例有11例,其他部位有11例,诊断时出现转移灶的病例有22例。免疫组化检测肿瘤标记物突触素、嗜铬粒蛋白、上皮膜抗原,将三种指标进行非参数检验统计比较,结果P0.05提示差异有统计学意义,EMA阳性率较其他两组低。至2014年1月失访病例有12例,随访时间为0-34个月,中位时间13.5个月。全部病例进行TNM分期,分组为Ⅱ、Ⅲ和Ⅳ期患者的2年生存率分别是68.6%、56.3%和26.3%。根据Ki-67增殖指数进行病理分级为未报告组、G1-2组、G3级,患者的2年生存率分别是41.5%、100%和35.5%。不同TNM分期和病理分级的患者生存率比较无统计学意义。全部病例的中位生存期为19个月。转移组22例与非转移组20例,2年生存率分别是28.5%、68.8%,转移组中位生存期15个月。手术治疗组26例和非手术治疗组16例患者2年生存率分别是71.2%和0,非手术组中位生存期12个月。胃肠道部位肿瘤患者20例中位生存期为19个月,2年生存率44.2%,支气管肺部位11例中位生存期为11个月,2年生存率0,肿瘤位于其他部位病例11例2年生存率88.9%。单因素分析显示是否手术、不同部位及病灶是否转移对患者生存期有影响,生存率比较差异有统计学意义(Log-Rank检验均有P0.05). Cox多因素分析显示手术为影响生存期的独立因素。 结论1.手术切除可明显改善该疾病患者的生存期。2.不同部位的神经内分泌肿瘤的患者生存期存在差异,出现转移灶的患者生存期较短。
[Abstract]:Objective the early clinical manifestation of neuroendocrine tumor (Neuroendocrine neoplasms) is usually atypical and the diagnosis is not clear. When the tumor develops or shows symptoms, the diagnosis is not timely, the treatment is unreasonable, and the prognosis of the patients is poor. According to the diagnosis and treatment of neuroendocrine tumors in our hospital, the clinical features, examination items, current treatment plans and prognostic survival factors of neuroendocrine tumors were discussed. Methods the clinical data, laboratory pathological examination and imaging data of 42 patients with neuroendocrine neoplasms from January 2011 to June 2013 were collected and analyzed. The survival conditions (median survival time and 2-year survival rate) of patients with different clinical characteristics were analyzed. The clinical experience was summarized and the related factors affecting the prognosis of the disease were discussed. Results A total of 42 cases of neuroendocrine tumors were collected, including 32 males and 10 females, ranging in age from 17 to 79 years, with a median age of 59 years. There were 20 cases of neuroendocrine tumors in the gastrointestinal and pancreatic system, 11 cases of bronchopulmonary system, 11 cases of other parts, and 22 cases of metastases at the time of diagnosis. Immunohistochemical detection of tumor markers synaptophysin, chromaffin, epithelial membrane antigen, the three indicators of non-parametric test statistical comparison, the results showed that there was significant difference between the two groups in EMA positive rate was lower than the other two groups. Up to January 2014, there were 12 cases of lost visit, the follow-up time was 0-34 months, the median time was 13. 5 months. The 2-year survival rates of patients with stage 鈪，

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