| Part One The Prognostic Analysis of 94 Patients of Gastroenteropan-- crean creatic Neuroendocrine NeoplasmObjectives:In order to explore the clinicopathological characteristics of gastroenteropancreancreatic neuroendocrine tumors(GEP-NENs) and find out the relationship between the clinical characteristics and survival of GEP-NENs.Method:Totally 94 patients with GEP-NENs in the Fourth Hospital of Hebei Medical University from January 2005 to February 2015 were analyzed retrospectively. We analyed the relationship between the clinical characteristics and survival of GEP-NENs.Results:Among the 94 patients with GEP-NENs, 65 were men and 29 were women, Male-to female ratio was 2.24:1. The onset age was 22-82 years, The median age was 60 years.The incidience of stomoach was highest and up to a total of 62 cases, followed by pancreas, a total of 24 cases, 4 cases in small Intestine, 4 cases in rectum.Endoscopic examination was performed on 67 patients, of which a lesion was found in 67 patients, promised a detection rate of 100%. CT was performed on 87 patients, of which a lesion was found in 85 patients, promised a detection rate of 97.7%.91 patients underwent the surgery with curative surgery(68 cases) and p-alliative surgery(22 cases). Endoscopic excision was performed on only 1 patient. 3 cases were treated conservative treatment. 94 cases of patients were reported the diameter of tumors. The onset diameter was 0.5-20 cm. 3 cases accounting for 3.2% were less than lcm, 12 cases accounting for 12.77% were 1-2cm, 79 cases accounting for 84.04% were more than 2cm. A total of 94 cases had described the infiltration layer, divided as T1, T2, T3 and T4 groups. The proportion is respectively 19.0%(15cases), 24.1%(19cases), 13.9%(11cases), 43.0%(34cases). Lymphatic metastasis occurred in 67.1% of patients respectively(49/73). The result showed that the positive rate of lymph nodes metastasis was 67.1%. Ki-67 index were assessed in 89 specimens. 15 cases(16.9%) of the tumors were ≤2%, 9 cases(10.1%) were 3-20% and 65 cases(30.2%) at >20%. Immunohistochemistry staining determined a 73.0% positive rate of Cg A, 100% positive rate of Syn and 49.2% positive rate of NSE.86 out of 94 patients received long-term follow up with a median duration of 36 months. The follow-up rate was 91.5%. 26 cases of patients dead. The overall survival rate was 69.8%. According to the results of survival analysis, Univariate analysis confirmed that male, rectum tumor, T1, T2 stages,no lymph nodes metastasis, less than 2% of Ki-67 positive index, medical treatment of platinum and fluorouracil and radical surgery treatment have a better prognosis. Tumor location of small intestine has a worse prognosis.Conclusions:The number of GEP-NENs is increasing year by year, Male has a higher morbidity and a better prognosis than female. The incidience of stomoach is highest, followed by the pancreas, while rectum, colon and small intestine are relatively rare. The main means of preoperative examination are endoscopy and CT. they combined with immunohistochemical tecnology can be used as auxiliary examination means. Syn, Cg A and NSE are the three most commonly immunohistochemical index used in diagnosis. Syn has a higher p-ositive rate. The combined detection of these index will has a higher accuracy. Surgical treatment is the main method. Patients with surgical treatment have a better prognosis. It can be concluded that male, rectum tumor, T1, T2 stages,no lymph nodes metastasis, less than 2% of Ki-67 positive index, medical treatment of platinum and fluorouracil and radical surgery treatment have a better prognosis. Tumor location of small intestine has a worse prognosis.Part Two The Prognostic Analysis of 80 Patients of Gastrointestinal- Cancer With Neuroendocrine Cell DifferentiationObjectives:The purpose of this study was to explore the clinicopathological characteristics of Gastrointestinal Cancer With Neuroendocrine Cell Differentiation(GICNED) and find out the relationship between clinical characteristics and the survival of GICNED.Method:A retrospective analysis of 94 patients with gastrointestinal cancer with NED in the Fourth Hospital of Hebei Medical University from January 2005 to February 2015 was to performed. We analyed the relationship between the clinical characteristics and survival of GICNED.Results:Among the 80 patients with GICNED, 71 were men and 9 were women, Male-to female ratio was 7.89:1. The onset age was 37-77 years, The median age was 61 years.77 patients underwent the surgery with curative surgery(58 cases) and palliative surgery(19 cases). 3 cases were treated conservative treatment because of distant metastasis. 75 cases of patients were reported the diameter of tumors. The onset diameter is 1.5-15 cm. The diameter of tumors less than 4cm accounts for 8.00%, While 4-7cm accounts for 58.67%. The diameter of tumor focus more than 7cm accounts for 33.33%. A total of 80 cases had described the infiltration layer, divided as T1, T2, T3 and T4 groups. The proportion is respectively 8.5%(8cases), 16.0%(15cases), 7.4%(7cases), 68%(64cases). Syn were assessed in 78 specimens, 72 were positive. The positive rate was 92.3%. 79 patients were assessed Cg A. 31 cases were positive. The positive rate is 39.2%. 65 patients were assessed NSE. 24 cases were positive and the positive rate is 36.9%.65 out of 80 patients received long-term follow up with a median duration of 24 months. The follow-up rate was 81.25%. 34 cases of patients dead. The overall survival rate was 47.7%. According to the results of survival analysis, Univariate analysis confirmed that gender and tumor location affectted the survival of patients. Male(P=0.047) and curative surgery(P=0.041) were benefit to the prognosis of patients.Conclusions:Immunohistochemical index was very important for clinical doctors to diagnose the gastrointestinal cancer with neuroendocrine cell differentiation. Patients with gastrointestinal cancer with neuroendocrine cell differentiation have a poorer prognosis than common gastrointestinal cancer. The differences in cases with different pathological grading about gender and tumour location were statistically significant. The tumor location and whether given surgical treatment are the factors which affectted the prognosis of patients. Female and non-surgical treatment were the independent indicators of poor prognosis. |
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