Clinicopathological Features And Analysis Of Prognostic Factors For Gastrointestinal Neuroendocrine Neoplasm

Objective： Currently prognostic factors of gastrointestinal neuroendocrineneoplasm(GI-NEN) still have many differences. We analyzed the clinical data ofpatients with GI-NEN, to explore the prognostic factors for them and provide areference basis for predicting clinical outcome of the disease.Methods: Retrospective analysis were conducted for the data of the patientsdiagnosed pathologically with GI-NEN at the First Affiliated Hospital of FujianMedical University during February2007to November2012.Analyzing the clinicalmanifestation, pathological feature and treatment as prognostic factors of patientswith GI-NEN. The primary endpoint was overall survival (OS), and we plotedthe survival curves of patients by Kaplan-Meier method. Log-rank method wasused to examine the factors influencing the prognosis. Multivariate Cox regressionanalysis was used to select the independent risk factors of the prognosis.Result: There were86patients diagnosed pathologically with GI-NEN and only75patients had been followed up. During the follow-up duration there were31deaths, all due to tumor recurrence after operation. Postoperative survival timeranged from1-53months, and the median survival time was26months. The1and3year survival rates were71.0%and46.0%respectively. Ages of diseasediagnosis were different significantly among patient groups of different sites(P=0.01). The average age of gastric NEN was60.3±8.5years old, and theaverage age of intestinal NEN was53.7±16.5years old. The clinicalmanifestations of all patients had no function, mainly were nonspecificgastrointestinal symptoms or local tumor occupying symptoms. Endoscopy andimaging showed occupying lesions. Univariate analysis showed that the degree ofsurgical, the maximum diameter of the tumor, pathological classification,histological grade, pathological stage, depth of invasion, lymph node metastasis,distant metastasis, vascular invasion, Ki-67index were found to be significantly associated with the prognosis and patient prognosis (P <0.05), while age, gender,tumor location, whether chemotherapy, pathological expression of CgA and Synhad no relationship(P＞0.05). Multivariate analysis showed independent riskfactors were advanced pathologic stage and vascular invasion. Pathologicalimmunohistochemical CgA and Syn were simultaneously expressed in53patients.The positive rate of CgA (57/71=80.3%) was lower than that of Syn (66/71=93.0%), and there was significant difference (P=0.027). The highest positiverate of CgA was in the small intestine(P=0.016) and Syn was in the pathologicstage I(P=0.008). No distant metastasis in patients had higher positive rate ofSyn(P=0.013). The expression of CgA and Syn were unrelated with gender,age, degree of differentiation, histological type, tumor size, depth of invasion,Ki-67index (P>0.05).Conclusions: GI-NEN lacked specific clinical manifestations and diagnosisrelied on pathology. Gastric NEN were diagnosed late, surgery was the maintreatment. Syn was more sensitive than CgA in the diagnosis of GI-NEN.Theexpression of CgA and Syn were not generally affected by patients.The postoperativepathologic stage and vascular invasion were independent prognostic factors inpatients with gastrointestinal neuroendocrine neoplasms.