摘要
目的探讨原发性肝脏神经内分泌肿瘤(HNEN)和消化道来源转移性HNEN的临床病理特征,筛选胃肠胰神经内分泌肿瘤(GEP-NEN)肝脏转移危险因素,分析原发性和转移性HNEN的临床特征差异、诊治和预后。方法回顾性分析2010年1月至2017年6月郑州大学第一附属医院收治的182例HNEN患者资料,包括39例原发性HNEN、129例消化道来源的转移性HNEN和14例原发灶不明的HNEN。采用卡方检验、t检验进行各组间的临床病理特征分析,logistic回归分析GEP-NEN肝转移的危险因素。采用Kaplan-Meier法和log-rank检验进行生存分析,Cox模型进行预后多因素生存分析。结果消化道来源转移性HNEN以男性多见(70.5%,91/129)。血清肿瘤标志物神经元特异性烯醇化酶、甲胎蛋白在原发性HNEN中的阳性例数分别为2例和1例,在转移性HNEN中的阳性率分别为37.2%(32/86)、6.4%(7/110)。原发性HNEN多为单发(61.5%,24/39),转移性HNEN以多发常见(78.3%,90/115)。原发性HNEN多发于肝右叶(44.7%,17/38),转移性HNEN多数肝左右叶同时发生(68.4%,78/114)。原发性HNEN与转移性HNEN的肿瘤个数、肿瘤病理分级、肿瘤发生部位和肿瘤最大径比较,差异均有统计学意义(χ2=21.264、11.696、19.461、4.547,P均<0.05)。原发性HNEN与转移性HNEN患者中位生存时间分别为17.0、10.0个月,两者生存曲线差异有统计学意义(χ2=7.235,P=0.007)。肝脏肿瘤类型(原发性或转移性)(P=0.002)、肿瘤病理分级(P=0.044)、有无淋巴结转移(P=0.024)、肿瘤生长方式(P<0.01)和治疗方式的选择(P=0.018)均是影响患者预后的独立因素。结论原发性HNEN与转移性HNEN肿瘤个数、大小和发生部位存在差异。肝脏肿瘤类型、病理分级、有无淋巴结转移、肿瘤生长方式和治疗方式是影响HNEN患者预后的独立因素。早期局部治疗、联合治疗有助于延长HNEN患者的生存时间。
Objective To explore the clinicopathological characteristics of primary hepatic neuroendocrine neoplasm(HNEN)and metastatic HNEN from digestive tract,to screen the risk factors of hepatic metastasis of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN)and to analyze the differences between primary and metastatic HNEN in clinical features,diagnosis,treatment and prognosis.Methods From January 2010 to June 2017,the clinical data of 182 patients with HNEN admitted at The First Affiliated Hospital of Zhengzhou University were retrospectively analyzed,including 39 cases of primary HNEN,129 cases of metastatic HNEN and 14 cases of HNEN with unknown primary lesions.Chi-square test and t test were performed to analyze the pathologic characteristics among groups.Logistic regression method was used to analyze the risk factors of hepatic metastasis.Kaplan-Meier method and log-rank test were used for survival analysis.Cox model was used for the prognostic multivariate survival analysis.Results Metastatic HNEN from digestive tract was more common in male(70.5%,91/129).The case number of serological tumor biomarkers neuronspecific enolase and alpha-fetoprotein positive in primary HNEN were two cases and one case,respectively,and the positive rates in metastatic HNEN were 37.2%(32/86)and 6.4%(7/110).Most primary HNEN was single lesion(61.5%,24/39),while multiple lesions were more common in metastatic HNEN(78.3%,90/115).Primary HNEN mainly occurred in the right lobe of the liver(44.7%,17/38),while metastatic HNEN located simultaneously in the left and right lobes of the liver(68.4%,78/114).There were significant differences between primary HNEN and metastatic HNEN in tumor number,pathological grading,location of tumors and maximum diameter of tumors(χ2=21.264,11.696,19.461 and 4.547,all P<0.05).The median survival time of patients with primary HNEN and metastatic HNEN were 17.0 months and 10.0 months,and there was a significant difference in survival curves between the two groups(χ2=7.235,P=0.007).The type of hepatic tumors(primary or metastatic)(P=0.002),pathological grading of hepatic tumors(P=0.044),lymph node metastasis(P=0.024),the growth pattern of tumors(P<0.01)and treatment methods(P=0.018)were the independent factors for the prognosis of patients.Conclusions There are significant differences between primary HNEN and metastatic HNEN in tumor number,size and location.The type of hepatic tumors,pathological grading,lymph node metastasis,growth pattern of tumors and treatment methods are the independent factors for the prognosis of patients.Early topical treatment and combination treatment can help to prolong survival time of HNEN patients.
作者
焦笑笑
王照地
张腾飞
张连峰
马望
周琳
Jiao Xiaoxiao;Wang Zhaodi;Zhang Tengfei;Zhang Lianfeng;Ma Wang;Zhou Lin(Department of Gastroenterology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Oncology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2019年第11期752-758,共7页
Chinese Journal of Digestion
基金
国家自然科学基金(81001103、81472325)。
关键词
肝肿瘤
癌
神经内分泌
病理学
肿瘤转移
预后
Liver neoplasm
Carcinoma
neuroendocrine
Pathology
Neoplasm metastasis
Prognosis
