Clinical features and prognosis of gastric neuroendocrine neoplasms / 中华消化外科杂志

ABSTRACT

Objective To investigate the clinicopathological features,treatment method and prognostic factors of the gastric neuroendocrine neoplasms (gNENs).Methods The clinical data of 80 patients with gNENs who were admitted to the Zhongshan Hospital of Fudan University from January 2002 to December 2011 were retrospectively analyzed.All the patients received gastroscopic examination.Patients with well-differentiated and diameter ≤ 2 cm gNENs received endoscopic mucosal resection or endoscopic submucosal dissection.Patients with poordifferentiated and diameter ＞ 2cm tumors received surgical resection of gNENs.Patients were followed up via phone call,mail or out-patient examination till October 31,2013.The Kaplan-Meier method was used for drawing the survival curve and calculating the survival rate.The univariate analysis was done by Log-rank test and the multivariate analysis was done by COX proportional hazards model.Results Fifty-eight patients had pain and discomfort in the epigastric region.Thirty-two gNENs were located at the cardia,40 at the body and 8 at the pylorus.Fortyfour gNENs were ulcerative type,25 were polypoid type,11 were protruded type.The mean diameter of the gNENs was 2.6 cm (range,0.4-7.5 cm).Twenty-seven gNENs were in grade 1,10 in grade 2 and 43 in grade 3.Forty-five gNENs were localized,34 gNENs had lymph node involvement (2 gNENs had distal metastasis),and 1 gNENs had distal metastasis.Thirty-one patients received endoscopic resection,and did not receive adjuvant therapy.Forty-nine patients (6 with gastric neuroendocrine tumor and 43 with gastric neuroendocrine carcinoma)received radical resection,including proximal subtotal gastrectomy in 16 patients,distal subtotal gastrectomy in 15 patients,total gastrectomy in 15 patients and distal subtotal gastrectomy + resection of the liver metastasis in 3 patients.Thirty-four patients received adjuvant chemotherapy and 15 did not receive adjuvant chemotherapy.Seventy-nine patients were followed up for a median time of 42.0 months (range,2.0-113.0 months).The mean time of survival was 75.6 months(range,2.8-100.8 months),and the 1-,3-,5-year overall survival rates were 91.3％,75.8％ and 66.5％,respectively.The 5-year survival rates of patients with gNENs in grade 1,grade 2 and grade 3 were 100.0％,100.0％ and 38.0％,respectively.The results of univariate analysis showed that the gender,treatment methods,adjuvant chemotherapy,types of tumor,tumor diameter,classification and staging of the tumor were correlated with the prognosis of the patients (x2=9.550,17.488,25.038,14.994,6.897,25.234,22.066,P ＜ 0.05).The results of multivariate analysis showed that the gender was the independent risk factor influencing the prognosis of the patients (RR =11.280,95％ confidence interval5.353-19.121,P ＜ 0.05).Conclusions The clinical presentations of gNENs are often nonspecific.The main presentation of gNENs is pain in the epigastric region of the abdomen,and most of the gNENs are located at the cardia or body of the stomach.The staging and grading of the gNENs are varied,and the prognosis is related with the gender of the patients.Endoscopic or surigcal resection is the main treatment method for gNENs.Female patients have a better prognosis than male patients.