ABSTRACT
OBJECTIVE： To observe the efficacy and safety of apatinib combined with systemic chemotherapy for hepatic metastasis of gastroenteropancreatic neuroendocrine neoplasms （GEP-NEN）. METHODS： Totally 60 patients with GEP-NEN in Hubei Provincial Tumor Hospital from Jan. 2016 to Jan. 2018 were randomly divided into systemic chemotherapy group， apatinib group and combination group， with 20 patients in each group. Systemic chemotherapy group was given Etoposide injection 80 mg/m2，once a day d1-5， intravenously+Cisplatin for injection 20 mg/m2，once a day d1-5，intravenously， every 3 weeks for a cycle. Apatinib group was given Apatinib mesylate tablets 0.5 g， once a day. Combination group received treatment as systemic chemotherapy group+apatinib group. All three groups were treated continuously for 3 months. The clinical efficacies of 3 groups were observed. The serum levels of tumor markers （CEA， NSE， CgA and CA19-9） before and after treatment， survival situation after treatment and the occurrence of ADR during treatment were also observed. RESULTS： The objective remission rate， disease control rate， median overall survival and survival rate of combination group were significantly higher or longer than those of systemic chemotherapy group and apatinib group. Median progression-free survival and the incidence of ADR were significantly shorter or lower than systemic chemotherapy group and apatinib group （P＜0.05）. After treatment， the levels of CEA， NSE， CgA and CA19-9 in 3 groups were significantly lower than before treatment， and combination group was significantly lower than systemic chemotherapy group and apatinib group （P＜0.05）. There was no statistical significance in above indexes between systemic chemotherapy group and apatinib group （P＞0.05）. CONCLUSIONS： Apatinib combined with systemic chemotherapy for liver metastasis of GEP-NEN is effective and safe， which can improve the level of serum tumor markers， prolong the survival time of patients and improve survival rate.
ABSTRACT
Objective To describe the MSCT manifestations of different pathological grading of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN)and to improve the understanding of CT characteristics of this disease.Methods MSCT images and pathological results of 38 GEP-NEN proved by surgical pathology were analyzed retrospectively in our hospital.All of the tumors were graded as G1 to G3.Measured respectively the CT value of the same location of each tumor in the noncontrast enhanced phase, arterial and venous phase.And divided them into mild,moderate and obvious.Statistically analyzed the number of tumors with different degree of enhancement.Results In arterial and venous phase of G1 group,the number of mild enhancement was respectively 3 and 0 case, the number of moderate enhancement was respectively 6 and 8 cases,and the number of obvious enhancement was respectively 7 and 8 cases.In arterial and venous phase of G2 group,the number of mild enhancement was respectively 2 and 0 case,the number of moderate enhancement was respectively 4 and 6 cases,and the number of obvious enhancement was respectively 4 and 4 cases.In arterial and venous phase of G3 group,the number of mild enhancement was respectively 9 and 4 cases,the number of moderate enhancement was respectively 3 and 8 cases,and the number of obvious enhancement was respectively 0 and 0 case.Kruskal-Wallis rank sum test was performed for the number of tumor enhancement,the result was P<0.05.Conclusion MSCT multi-phase enhancement is valuable in judging the pathological grade of GEP-NEN.Arterial phase usually shows moderate to obvious enhancement in G1 group.The enhancement of tumors with higher grade shows a trend of decrease in arterial phase,while shows mild to moderate enhancement in venous phase.
ABSTRACT
Neuroendocrine neoplasm (NEN)is a group of heterogeneous tumors originated from the peptidergic neurons and neuroendocrine cells. A revised system of classification, nomenclature and grading of NEN was proposed by the fourth edition of“World Health Organization classification of tumours of the digestive system”in 2010. It apparently contributes to unify the method of classification, put an end of the confusion in nomenclature, standardize the grading system and predict the outcomes more accurately. With the combination of the results by immunohistochemical studies, pathologists should be in accordance with the requirements to make a diagnosis of NEN with accurate classification, grading and the pathological parameters essential to staging. Recently, new advances in NEN study put forward a new view in the classification and grading system that will lead to the updates of the diagnostic system after further studies on a large scale of samples.