胃肠胰神经内分泌肿瘤临床病理特征及预后分析

发布时间：2018-04-17 12:24

本文选题：胃肠胰 + 神经内分泌肿瘤　；参考：《北京协和医学院》2017年硕士论文

【摘要】：[目的]探讨胃肠胰神经内分泌肿瘤临床病理特征及影响预后的因素,进一步为GEP-NENs早期诊断、治疗提供参考依据。[方法]回顾性分析2001-2010年就诊于中国医学科学院肿瘤医院的GEP-NENs确诊病例(共232例),随访日期截止于2016年7月。采用SPSS 18.0进行统计学分析,采用Kaplan-Meier绘制生存曲线并计算生存率,单因素生存分析采用log-rank检验,多因素生存分析采用Cox比例风险回归模型。所有P值均为双侧检验,P0.05具有统计学意义。[结果]本组病例中,年龄、性别、不良嗜好等因素在不同病理分级之间均具有统计学差异。共116例表现出明显临床症状,以腹泻、消化不良为主要临床症状,表现为Zollinger-Ellison综合征、whipple三联征、类癌心脏病各有1例。胃肠镜、CT对于GEP-NENs的检出率高达100%、91.3%。有效随访病例227例,随访时间为1-187个月,总体中位生存时间为80个月,1、3、5年生存率分别为83.7%、68.3%和63.9%。进行单因素分析结果显示:年龄、性别、不良嗜好、肿瘤浸润深度、淋巴结转移、远处转移、肿瘤分级、病理切缘情况、有无脉管瘤栓及神经侵犯均与患者的预后有关(P0.05)。进行COX回归分析后提示:年龄、性别、远处转移情况是影响患者预后的独立因素。[结论]GEP-NENs多无特异性临床症状,以占位性病变引起的排便性质改变、进食不顺为主要表现。胃肠镜和CT是主要诊断手段,进行手术切除是目前最有效的治疗手段。患者的年龄、性别及病灶是否存在远处转移都是预后的相关因素。早期诊疗仍然是有待解决的重要问题。[目的]探讨直肠神经内分泌肿瘤(RNETs)临床病理特征及预后,进一步为直肠神经内分泌肿瘤的规范化诊疗提供参考依据。[方法]回顾性分析2001-2010年在中国医学科学院肿瘤医院诊断232例胃肠胰神经内分泌肿瘤中的109例直肠神经内分泌肿瘤患者的临床特征、病理及随访资料。通过Kaplan-Meier法分析受试者预后生存情况,利用Cox等比例风险模型来探索影响直肠神经内分泌肿瘤预后的独立危险因素。[结果]109例直肠神经内分泌肿瘤患者中,直肠神经内分泌瘤(RNETs)患者91例(83.48%)、直肠神经内分泌癌(RNECs)患者和未知分级患者各占9例(8.26%)。患者的平均年龄为50.58(士 11.90)岁,男女性别比例为1.51:1,且多数患者(90.83%)为城镇户口。本组109例患者的3年、5年和10年生存率分别为91.23%、88.20%和84.20%。年龄、淋巴结转移情况和远处转移情况是影响直肠神经内分泌肿瘤预后的独立危险因素。[结论]直肠神经内分泌肿瘤多发生于城镇地区的中年男性人群,预后较好。年龄、淋巴结转移情况和远处转移情况是直肠神经内分泌肿瘤预后的独立危险因素。
[Abstract]:[objective] to investigate the clinicopathological features and prognostic factors of gastrointestinal and pancreatic neuroendocrine tumors, and to provide reference for early diagnosis and treatment of GEP-NENs.[methods] A retrospective analysis was made of 232 cases of GEP-NENs diagnosed in Cancer Hospital of the Chinese Academy of Medical Sciences from 2001 to 2010. The follow-up date ended in July 2016.SPSS 18.0 was used for statistical analysis, Kaplan-Meier was used to draw survival curve and survival rate was calculated, log-rank test was used for univariate survival analysis, and Cox proportional risk regression model was used for multivariate survival analysis.All P values were bilateral test (P0.05) with statistical significance.[results] Age, sex, bad habits and other factors were statistically different in different pathological grades.A total of 116 cases showed obvious clinical symptoms, with diarrhea and indigestion as the main clinical symptoms. The main symptoms were Zollinger-Ellison syndrome whipple triple sign, carcinoid heart disease in 1 case each.The detection rate of GEP-NENs by gastroenteroscopy CT was as high as 91.3%.227 cases were followed up for 1-187 months, the median survival time was 80 months and the 5-year survival rate was 83.7% and 63.9%, respectively.Univariate analysis showed that age, sex, bad habits, depth of tumor invasion, lymph node metastasis, distant metastasis, tumor grade, pathological margin, vascular embolus and nerve invasion were all related to the prognosis of the patients.COX regression analysis showed that age, sex and distant metastasis were independent factors of prognosis.[conclusion] there is no specific clinical symptom in GEP-NENs. The main manifestation of GEP-NENs is the change of defecation character caused by space occupying disease and improper eating.Gastroenteroscopy and CT are the main diagnostic methods, surgical resection is the most effective treatment.Age, sex and distant metastasis are all prognostic factors.Early diagnosis and treatment is still an important problem to be solved.[objective] to investigate the clinicopathological features and prognosis of rectal neuroendocrine tumors (RNETs), and to provide a reference for the standardized diagnosis and treatment of rectal neuroendocrine tumors.[methods] the clinical features, pathology and follow-up data of 109 patients with rectal neuroendocrine tumors in 232 cases of gastrointestinal and pancreatic neuroendocrine tumors diagnosed in the Cancer Hospital of the Chinese Academy of Medical Sciences from 2001 to 2010 were retrospectively analyzed.The survival status of the subjects was analyzed by Kaplan-Meier method, and the independent risk factors affecting the prognosis of rectal neuroendocrine tumors were explored by using Cox and other proportional risk models.[results] among 109 patients with rectal neuroendocrine tumors, 91 patients with rectal neuroendocrine tumors (RNETs) were treated with RNECs, 9 patients with rectal neuroendocrine carcinoma (RNECs) and 9 patients with unknown grade (RNECs).The average age of the patients was 50.58 (+ 11.90), the ratio of male to female was 1.51: 1, and the majority of the patients were urban hukou.The 3-year, 5-year and 10-year survival rates of 109 patients were 91.2388.20% and 84.20%, respectively.Age, lymph node metastasis and distant metastasis are independent risk factors for prognosis of rectal neuroendocrine tumors.Conclusion: rectal neuroendocrine neoplasms mostly occur in middle-aged men in urban areas, and the prognosis is good.Age, lymph node metastasis and distant metastasis are independent risk factors for prognosis of rectal neuroendocrine tumors.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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