Analysis of clinicopathologic features, diagnosis and treatment of 405 cases with gastroenteropancreatic neuroendocrine neoplasm / 中华消化杂志

ABSTRACT

Objective To explore the clinicopathologic characteristics,to screen risk factors of metastasis and to analyze the diagnosis,treatment and prognosis of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).Methods From January 2010 to November 2015,the clinical data of 405 patients with GEP-NEN were retrospectively analyzed.GEP-NEN tumors were classified as neuroendocrine tumor (NET,G1 and G2 grade),neuroendocrine carcinoma (NEC,G3 grade) and mixed adenoendocrine carcinoma (MANEC,G3 grade).The clinicopathologic characteristics were summarized.The staining characteristics of synaptophysin (Syn),chromogranin A (CgA) and CD56 of tumor tissues were analyzed by immunohistochemistry.x2 and t test were performed to analyze differences in pathologic characteristics between groups.Logistics regression method was used to analyze the risk factors of metastasis.KaplanMeier method and Log-rank test were used for survival analysis.Results The mean age of patients with GEP-NEN was (54.7± 13.3) years.Gastric NEN was the most common GEP-NEN (98 cases,24.2％),followed by 95 cases (23.5％) with NEN in rectum,86 cases (21.2％) in pancreas and 50 cases (12.3％)in esophagus.Among them,47 cases (11.6％) were functional GEP NEN and 358 cases (88.4％) were non-functional GEP-NEN.According to pathologic diagnosis,227 cases (56.0％) were NET,125 cases (30.9％) were NEC and 16 cases (4.0％) were MANEC.According to tumor classification,120 cases (29.6％) were grade G1,108 cases (26.7％) were grade G2 and 177 cases (43.7％) were grade G3.Immunohistochemistry staining positive ratesof Syn,CgA and CD56 were 97.4 ％ (381/391),44.0 ％ (121/275) and 83.9％(291/347),respectively.The median (lower quartile,upper quartile) diameter of grade G1,G2 and G3 tumors were 1.0 cm (0.6 cm,1.5 cm),1.5 cm (1.0 cm,2.5 cm),4.0 cm(2.5 cm,6.0 cm),respectively,and the difference was statistically significant (Z =99.171,P ＜ 0.01).The positive rate of CgA of grade G3 tumor was lower than that of grade G1 and G2(x2 =7.078 and 11.391,both P＜ 0.01).The results of Logistic regression analysis revealed that tumor size and pathologic classification were the important predictors of metastasis.The median survival time of metastasis group and non-metastasis group of grade G3 was 12.0 months and 41.5 months,and there was a significant difference between the two groups by Log-rank test (x2 =37.075,P＜0.01).Conclusions GEP-NEN may occur at any part of the digestive system.There are differences in tumor size positive rate of,immunohistochemistry staining and the primary site of tumors with different pathological grading.The tumor diameter and pathologic classification are the important predictors of metastasis.The prognosis of metastasis group is worse than that of non-metastasis group.