| Background:Gastric neuroendocrine neoplasm (G-NEN) includes well-differentiated neuroendocrine tumors (NETs) and poorly-differented carcinoma (NEC), The well-differentiated NETs are classified into three categories:type I, associated with type A atrophic gastritis, Although it got highly recurrence rate, But prognosis is good.Type II, associated with Zollinger-llison syndrome/multiple endocrine neoplasia-1 (MEN-1), Type III, are sporadic NETs with no specific background disease. Because of the highly recurrence rate and the indolent behavior of the type I gastric neuroendocrine tumor, the serial endoscopic controls and lesion removal are common approaches, but, the data of treating this type NETs is few in TCM(Traditional Chinese Medicine), the recurrence data is fewer. The aim of our study was to evaluate the recurrence survival and recurrence rate of the type I G-NEN in modified XiaoYao powder and XiangShaLiuJunZi decoction.Methods:38 patients were diagnosed type I G-NEN until from June 2012 to February 2015 in China-Japan Friendship Hospital,28 patients received TCM therapy,19 patients were follow-up For more than 9 months. Don’t conduct the syndrome differentiation of TCM, all patients adopted modified XiaoYao powder and XiangShaLiuJunZi decoction. In the first visit, recording the physical data, clinical feature, detected fasting serum gastrin, serum chromogranin A(CgA), parietal cell antibody(PCA), measured 24h gastric acidity, serum vitamin B12, serum iron, blood routine tests, etc, described the baseline characteristics of patient. Endoscopic was done every 6-12months, described the gastric map, and multiple gastric biopsies(gastric fundus, body, antrum and lesions), the specimens were stained by HE and immunohistochemical staining, described the athrophic gastritis, ECL-cell pattern in detail. Serum gastrin and serum CgA were detected every 3-6 months. Th main endpoint of this study was the recurrence-free survival(RFS). Evaluated the relativity between serum gastrin,serum CgA with the recurrence.Results:The baseline characteristics of the 38 patients:20(53%) females, median age 53.5(30-82) years, The clinical features of the patients mainly were epigastrium distension(68.4%), belching(65.8%). All the patients had hypergastrinemia, x±s was 754.2±542.6pg/ml, the 300-500pg/ml interval was 18%, the 500-1000pg/ml interval was 47%. the serum CgA level rose up in 89.5% of patients, x±s was 309.8±356.2ng/ml, the 100-300ng/ml interval was 55%, the 300-1000ng/ml interval was 29%. the PCA positive rate was 72.7%, achlorhydria was 92.9%, serum vitamin B12 deficiency was 60.7%. The lesions mostly were in gastric fundus and body, multiple, polyp-like, the diameter<1.0cm was 81.6%, the lesions were mostly limited to mucosa or submucosa,2 cases were intromucosal NETs. NET Gl was 89.5%.19 patients were follow-up, median follow-up time was 20(9-33)months, 7(37%) patients had tumor recurrence, median RFS was 15(4-26)months. The fluctuations of serum gastrin and CgA level were first decreased and then increased in recurrence patients, the rising point was around the recurrence, the level with no recurrence patients were slowing down decline, while the level would increase when the ECL cell had hyperplasia obviously. The prognosis of the type I G-NEN is good, during the follow-up, survival rate was 100%, with no lymph node and distance metastases.Conclusion:The type I G-NEN is rare disease, has highly recurrence rate, The statistics of the 38 patients made up for the lack of National data.19 patients were follow-up For more than 9 months, the recurrence rate was lower than endoscopic management in modified XiaoYao powder and XiangShaLiuJunZi decoction, and the RFS was longer,so our prospective study has important clinical significance in preventing the recurrence of the type I G-NEN.
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