结直肠神经内分泌肿瘤116例临床病理及预后分析

发布时间：2018-05-06 06:13

本文选题：结直肠神经内分泌肿瘤 + 诊断　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:对结直肠神经内分泌肿瘤患者的临床病理资料进行分析,并探讨其与预后的关系。旨在为临床结直肠神经内分泌肿瘤患者的诊治提供一定的帮助。方法:回顾性分析2005年1月至2016年12月期间就诊于河北医科大学第四医院的116例结直肠神经内分泌肿瘤患者的临床病理资料及随访资料。统计分析患者临床病理特征及其与预后的关系。结果:本研究共入组116例结直肠神经内分泌肿瘤患者,男性84例,女性32例,男女比例为2.63:1。发病年龄从22岁到77岁,平均57±11.5岁,高发年龄段50-70岁。73例为直肠神经内分泌肿瘤,43例为结肠神经内分泌肿瘤。其中14例(12.1%)位于盲肠、10例(8.6%)位于升结肠、5例(4.3%)位于横结肠、6例(5.2%)位于降结肠、8例(6.9%)位于乙状结肠。肿瘤的平均直径为9.96±11.09mm(2mm-80mm)。98例肿瘤(84.5%)直径≤10mm;10例(8.6%)10mm,≤20m;8例(6.9%)直径20mm。其中肿瘤直径20mm,≤50mm,6例;肿瘤直径50mm,≤80mm,2例。其中结直肠NET G1:74例(63.79%),结直肠NET G2:32例(27.59%),结直肠NEC:7例(6.03%),MANEC:3例(2.58%)。T分期:T1为102例(87.93%);T2为2例(1.72%);T3为5例(4.31%);T4为7例(6.03%)。Syn(突触囊泡蛋白,Synaptophysin)的阳性率为80%,CgA(嗜铬粒蛋白A,Chromogranin A)的阳性率为45.1%,NSE(神经元特异性烯醇化酶,neuron-specific enolase)的阳性率为60.2%。结肠及直肠NENs患者Syn的阳性率分别为78.05%、69.57%;结肠及直肠NENs患者CgA的阳性率分别为43.90%、45.83%;结肠及直肠NENs患者NSE的阳性率分别为64.29%、58.18%。本研究共统计了116例结直肠NENs患者,其中13例患者出现淋巴结转移,103例未发现淋巴结转移。远处转移主要脏器为肝脏。其中1例发现时已有肝脏、肺脏、骨、远处多发淋巴结转移,1例发现时已有肝脏、肺脏、腹腔多发淋巴结转移,2例发现时已有肝脏、腹腔内及腹膜后多发淋巴结转移。本研究共统计了116例结直肠nens患者,其中101患者进行了内镜下治疗,行内镜黏膜吸引切除术(endoscopicmucosalresectionwithcap,emrc)的患者为56例,行内镜黏膜切除术(endoscopicmucosalresection,emr)的患者为31例,行内镜黏膜下剥离术(endoscopicsubmucosaldissection,esd)的患者为14例。其中2例(1.98%,2/101)在内镜切除术后,出现迟发性出血的并发症,后经止血药物治疗及内镜下止血治疗,症状消失出院。11例患者行根治性手术切除;2例发现时已有肝脏转移,行姑息性手术治疗;其中1例发现时已有肝脏、肺脏转移,给予化疗及对症治疗;1例发现时已有肝脏、肺脏、骨转移,发现后未治疗,自动出院。116例患者中,101内镜下治疗的患者,治疗后定期复查,未给予特殊治疗;另外15例患者,9例给予化疗,1例发现时已有肝脏、肺脏、骨转移,发现后未治疗,自动出院;5例手术后出院,术后未行化疗。116例结直肠nens患者中:失访8例,有效随访数据共有108例,随访率为93.10%,随访到的患者中,疾病稳定的患者99例,疾病进展的患者7例,死亡的患者2例,其中,最长随访时间为118个月,最短随访时间2个月;中位随访时间为33.76±26.43个月。死亡2例,均为肿瘤进展、复发、转移引起的死亡。总生存率为98.28%。随访到的108例结直肠nens患者中,结直肠netg1:66例,平均生存时间为33.47±27.87个月,均为内镜治疗的g1级的患者,全部存活,1年、3年、5年生存率均为100%。结直肠netg2:32例,平均生存时间为30.12±22.35个月,27例为内镜治疗的患者全部存活,1年生存率为100%,3年生存率为95%,5年生存率为83%。结直肠nec:7例,平均生存时间为19.56±17.24个月,1年生存率为85.7%,3年生存率为42.9%,5年生存率为14.3%。manec:3例,平均生存时间为16.7±7.74个月,1年生存率为66.7%,3年生存率为33.3%,5年生存率为0%。肿瘤大小(p=0.028)、g分级(p=0.011)、肿瘤浸润深度(t分期)(p=0.001)、淋巴结是否转移(P=0.035)、Ki-67指数(P=0.001)及是否远处转移(P=0.019)是影响患者预后的独立因素。结论:结直肠NENs的发病率逐年上升,男性发病率明显高于女性,好发部位为直肠;高发年龄段为50-70岁。结直肠NENs的临床表现中类癌综合征较少见。肿瘤的大小、分级、分期与结直肠NENs预后密切相关。肿瘤大小(P=0.028)、G分级(P=0.011)、肿瘤浸润深度(T分期)(P=0.001)、淋巴结是否转移(P=0.035)、Ki-67指数(P=0.001)、治疗方法(P=0.022)、远处是否转移(P=0.019)之间患者预后有明显差异。肿瘤直径≤10 mm,病理分级为G1级的,肿瘤分期T1,能够接受内镜治疗的预后好;肿瘤直径20mm,Ki-67指数越高,肿瘤T分期、G分级越晚,有淋巴结、远处脏器转移的,不能接受手术治疗的患者预后差。
[Abstract]:Objective: to analyze the clinicopathological data of the patients with colorectal neuroendocrine tumors and to explore the relationship between them and the prognosis. The purpose is to provide some help for the diagnosis and treatment of the patients with colorectal neuroendocrine tumors. Methods: a retrospective analysis of 116 cases in the fourth hospital of Hebei Medical University from January 2005 to December 2016. The clinicopathological data and follow-up data of the patients with rectal neuroendocrine tumor. Statistical analysis of the clinicopathological features and the relationship with the prognosis. Results: 116 cases of colorectal neuroendocrine tumors were included in this study, 84 males and 32 females. The age of 2.63:1. was from 22 to 77 years, with an average of 57 11.5 years and high incidence. .73 cases aged 50-70 years were rectal neuroendocrine tumors and 43 cases were colon neuroendocrine tumors, of which 14 cases (12.1%) were located in the cecum, 10 (8.6%) located in the ascending colon, 5 (4.3%) located in the transverse colon, 6 (5.2%) located in the descending colon and 8 (6.9%) in the sigmoid colon. The average diameter of the tumor was 14 11.09mm (2mm-80mm).98 tumor (84.5%). Diameter was less than 10mm; 10 cases (8.6%) 10mm, less than 20m; 8 cases (6.9%) diameter 20mm. in which the diameter of the tumor was 20mm, < 50mm, 6 cases; the diameter of the tumor 50mm, < 80mm, 2 cases. Among them, the colorectal NET G1:74 (63.79%), colorectal NET G2:32 (27.59%), colorectal carcinoma (2.58%); 2.58%) For example (6.03%) the positive rate of.Syn (synaptic vesicle protein, Synaptophysin) was 80%, and the positive rate of CgA (chromogranin A, Chromogranin A) was 45.1%. The positive rate of NSE (neuron specific enolase, neuron-specific enolase) was 78.05% and 69.57%, respectively, for 60.2%. colon and rectal NENs patients. The positive rates were 43.90% and 45.83%, respectively, and the positive rate of NSE in colon and rectal NENs patients was 64.29% respectively. In this study, 116 cases of colorectal NENs were counted, of which 13 cases had lymph node metastasis, 103 cases had no lymph node metastasis. The main organ of distant metastasis was liver. Among them, 1 cases had liver, lung, bone and far away. 1 cases of lymph node metastasis were found in the liver, lungs and abdominal cavity, 2 cases had liver, intraperitoneal and retroperitoneal lymph node metastasis in the 1 cases, and 116 cases of colorectal cancer were found in this study, of which 101 were treated by endoscopy and underwent endoscopic mucosal attraction excision (endoscopicmucosalresectionwithca P, emrc) patients were 56, 31 patients with endoscopic mucosal resection (endoscopicmucosalresection, EMR) and 14 patients with endoscopic submucosal dissection (endoscopicsubmucosaldissection, ESD). 2 (1.98%, 2/101) had delayed bleeding complications after endoscopic resection, followed by hemostasis and endoscopy. Blood treatment, symptoms disappeared and discharged.11 patients for radical resection; 2 cases had liver metastases and palliative surgery; 1 of them had liver, lung metastasis, chemotherapy and symptomatic treatment, and 1 cases had liver, lung, bone metastases, untreated, 101 endoscopy. After treatment, the patients were rechecked regularly, and no special treatment was given. The other 15 patients, 9 patients received chemotherapy, 1 cases had liver, lung, bone metastases, untreated and discharged after discovery; 5 cases were discharged after operation, and after operation,.116 cases of colorectal NENS patients were not treated with chemotherapy, 8 cases were lost and 108 cases were followed up effectively, the follow-up rate of follow up was 93.10%. The patients were followed up with 99 patients with stable disease, 7 patients with progressive disease and 2 cases of death, of which the longest follow-up time was 118 months and the shortest follow-up time was 2 months; the median follow-up time was 33.76 + 26.43 months. 2 cases died of tumor progression, recurrence and metastasis. The total survival rate was 108 cases followed up at 98.28%.. The average survival time was 33.47 + 27.87 months in the colorectal NENS patients. The average survival time was 33.47 + 27.87 months. All were endoscopically treated patients with grade G1. All survived, 1 years, 3 years, and 5 year survival rates were netg2:32 cases of 100%. colorectal. The average survival time was 30.12 + 22.35 months. 27 patients survived endoscopically. The 1 year survival rate was 100%, 3 years. The survival rate was 95%, the 5 year survival rate was 83%. colorectal nec:7 cases, the average survival time was 19.56 + 17.24 months, the 1 year survival rate was 85.7%, the 3 year survival rate was 42.9%, the 5 year survival rate was 14.3%.manec:3 cases, the average survival time was 16.7 + 7.74 months, 1 year survival rate was 66.7%, and the survival rate was 0%. tumor size (p=0.028), G classification (p=0.028). P=0.011), the depth of tumor invasion (T staging) (p=0.001), lymph node metastasis (P=0.035), Ki-67 index (P=0.001) and distant metastasis (P=0.019) are independent factors affecting the prognosis of the patients. Conclusion: the incidence of NENs in colorectal cancer is increasing year by year, the incidence of male is obviously higher than that of women, the location of good hair is rectum, and the age of high incidence is 50-70 years. Carcinoid syndrome is rare in the clinical manifestations of intestinal NENs. Tumor size, classification, and staging are closely related to the prognosis of colorectal NENs. Tumor size (P=0.028), G grade (P=0.011), T stage (P=0.001), lymph node metastasis (P=0.035), Ki-67 index (P=0.001), treatment method (P=0.022), distant metastasis (P=0.019)) The prognosis of the patients was significantly different. The tumor diameter was less than 10 mm and the pathological grade was G1. The tumor stage was T1 and the prognosis of the endoscopy was better. The diameter of the tumor was 20mm, the higher the Ki-67 index, the T staging of the tumor, the later the G classification, the lymph nodes, the distant viscera metastasis, and the poor prognosis of the patients who were not treated by the operation.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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