摘要
目的探讨胰腺神经内分泌肿瘤（PanNETs）的临床病理特点、诊断、治疗以及预后。方法回顾性分析88例PanNETs患者的临床资料，包括年龄、性别、症状、肿瘤大小、病理诊断、TNM分期、治疗以及随访情况，并探讨与预后相关的因素。结果88例患者中，男性28例，女性60例，男女之比1：2．1，年龄8～75岁，平均42岁。88例中无功能型74例（84．1％），功能型14例（15．9％）。根据AJCC7版TNM分期标准，本组88例中I期23例（26．1％），Ⅱ期46例（52．3％），Ⅲ期13例（14．8％），Ⅳ期6例（6．8％）。依据WHO2000年病理分类标准，高分化神经内分泌肿瘤35例（39．8％），高分化神经内分泌癌29例（33．0％），低分化神经内分泌癌24例（27．2％）。33例检测嗜铬粒蛋白A的患者中，27例（81．8％）阳性表达，41例检测突触素的患者中，38例（92．7％）阳性表达。全组患者5年总体生存率为72．0Vo。单因素分析显示肿瘤大小、AJCCTNM分期、病理分类、是否行根治性手术与预后相关。多因素分析显示TNM分期、病理分类以及是否行根治性手术是该组病例的独立预后影响因素。结论PanNETs是一类低度恶性的异质性罕见肿瘤。其临床表现多样，术前误诊率高，确诊依赖病理。新版TNM分期及病理分类能积极指导预后评价。患者经积极手术或以手术为主的综合治疗可获得较好的预后。
Objective To analyze the clinicopathological characteristics, diagnosis, treatment outcomes and prognosis of patients with pancreatic neuroendocrine tumors （PanNETs）. Methods The clinicopathological characteristcs and prognostic factors of 88 patients who were diagnosed with pancreatic neuroendocrine tumors by postoperative pathology were analyzed retrospectively. The data included age, sex, symptoms, tumor size, pathological grades, TNM staging, treatment and follow up. Results There were 28 males and 60 females. The ratio of male to female was 1 ： 2.1, with a mean age of 42 （range 8-75） years. Of the 88 PanNETs, 74（84.1%） were nonfunctional tumors. Using the WHO 2000 pathological classification system, there were 35 well differentiated endocrine tumors （WDET）, 29 well differentiated endocrine carcinomas （WDEC）, and 24 poorly differentiated endocrine carcinomas （PDEC）. Using the 7th AJCC TNM staging system, 23（26.1%）, 46 （52.3%）, 13（14.8%） and 6 patients （6.8%） were diagnosed to have stage Ⅰ , Ⅱ, Ⅲ and Ⅳ, respectively. The overall 5-year survival rate was 72.0 %. Univariable analysis revealed tumor size, histopathological grades, TNM staging and radical surgery were associated with prognosis. Multivariate analysis showed histopathological grades, TNM staging and radical surgery were independent risk factors of survival. Conclusions PanNETs are rare pancreatic neoplasms with high heterogeneity and low malig- nant potential. PanNETs have various clinical manifestations and the preoperative misdiagnosis rate is high. A definitive diagnosis depends on pathological examination. The new TNM and pathological classification systems have good predictive abilities on survival. The majority of patients who received radical surgery or surgical comprehensive therapy have good prognosis.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2013年第10期730-733,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
胰腺肿瘤
诊断
治疗
预后
Pancreatic neoplasms
Diagnosis
Therapy
Prognosis
