| Background and objective:The incidence of GI-NENs was low in the past, but in recent years, some statistical analysis has showed that its incidence is on the rise year by year, so the diagnosis and treatments of GI-NENs has received more and more attention. There is considerable variability in the biological characteristics, pathological characteristics and prognosis of GI-NENs, and most patients lack of typical clinical manifestations.Nowadays, unified understanding on the therapy and prognosis factors of GI-NENs has not been reached between domestic and foreign scholars yet.Based on the clinical pathologic data and treatments of GI-NENs patients were analyzed, to explore the risk factors of prognosis in GI-NENs patients, with the hope to draw the attention of this tumor from the clinicians and to provide reference basis of the diagnosis, treatments and assessment of prognosis of GI-NENs clinically.Methods:Patients with GI-NENs who were confirmed by pathological diagnosis in the First Hospital of Jilin University from January 2010 to September 2015 were selected. A retrospectively analysis of the clinical data of these patients, including clinicopathological features such as age, gender, tumor location, tumor size, clinical manifestations, and treatments. Subsequently, we followed up the survival situation of these patients. Finally, using Log-rank single factor analysis and Cox regression analysis to analyze the correlation between these clinicopathological features,treatments and prognosis in gastrointestinal neuroendocrine neoplasms patients.Results:1. A total of 168 cases of patients with GI-NENs were enrolled in our research,including 114 cases of male patients and 54 cases of female patients, their ratio was2.11:1.The median age was 57.5 years old, the peak age of onset ranged from 50 to 69 years old. The median survival time was 28 months.2. No functional GI-NENs accounted for 95.8%, and functional GI-NENs accounted for 4.2%, presented with diarrhea or facial skin flushing.3. According to the tumor location, stomach, small intestine, colon and rectum respectively accounted for 27.3%, 8.9%, 5.4%, 58.3%. According to the morphological type, uplift type, ulcer type, polyp type, nodular type, erosion type respectively accounted for 63.7%, 23.4%, 9.1%, 1.9%, 1.9%. And the stomach was ulcer type mainly(69.2%), and the rectum was uplift type mainly(92.3%). The smallest diameter of tumor size was 0.15 cm, and the maximum diameter was 20 cm.In pathological types, NET, NEC, MANEC respectively accounted for 64.9%, 30%,7.1%, of which gastric NENs was mainly neuroendocrine carcinoma(61%),colorectal NENs was mainly neuroendocrine tumor(82.6%). In the clinical stage,phase I, phase II, phase III and phase IV accounted for 53.2%, 18.5%, 9.8%, 18.5%,N1 accounted for 24.2%(37/153), GI-NENs was mainly hematogenous metastasis,most often metastasize to the liver(18/23), lymph node metastasis was rare.4. The positive rate of Cg A, CD56 and Syn were 62.2%, 90.6% and 96.2%,respectively. The positive rate of Cg A was significantly higher than that of CD56 and Syn(P<0.05). Cg A positive rate in the stomach, small intestine, colorectal were80.5%, 80.0%, 52.6%, CD56 positive rate in the stomach, small intestine, colorectal were 83.3%, 88.9% and 94.2%, Syn positive rate in the stomach, small intestine,colorectal were 90.9%, 100.0% and 98.1%. Through statistical analysis, Syn and CD56 positive rate were not related to tumor location(P>0.05), Cg A positive rate was related to tumor location, and Cg A positive rate in stomach and small intestine was higher than that of colorectal(P<0.05).5. In the pathological classification, G1, G2, G3 respectively accounted for56.0%, 8.9%, 35.1%. Using nuclear fission image number and Ki-67 index to carry out pathological grading respectively, the level of inconsistency accounted for 11.1%.According to statistical analysis, age, gender, tumor site, tumor size, T stage, vascular invasion, perineural invasion, regional lymph node metastasis, distant metastasis, Cg Apositive rate were all related with pathological grading. And patients with older, male,gastric site, the larger diameter of tumor, last T stage, the presence of vascular and nerve invasion, lymph node metastasis and distant metastasis, had a higher degree of malignancy and a higher pathological grade.6. 61.9% patients underwent surgical treatment, 31.0% patients underwent endoscopic resection. Chemotherapy after surgery in 21 cases, palliative chemotherapy in 4 cases, only 1 case of neoadjuvant chemotherapy. In addition, there were 3 patients were treated with radiotherapy, and 5 patients were treated with cell biology therapy.7. Through single factor analysis, GI-NENs prognosis were related with age,tumor location, tumor size, T stage, lymph node metastasis, distant metastasis, clinical stage, vascular invasion, perineural invasion, Ki-67 index, pathological classification(P<0.05), and had nothing to do with gender, Cg A, CD56 and Syn positive rate. The prognosis of postoperative G3 patients was not related to the adjuvant chemotherapy(P>0.05). Older, gastric site, presence of vascular and nerve invasion, last T stage,lymph node metastasis and distant metastasis, higher Ki-67 index, mixed adenoendocrine carcinoma patients with poor prognosis. By further COX analysis, T stage, clinical stage, pathological classification were the independent prognostic factors of GI-NENs.Conclusions:1. GI-NENs can be in all ages, the incidence of peak period is from 50 to 69 years old. The incidence of the disease is related to sex, the incidence of male is higher than female. The median survival time of GI-NENs is 28 months.2. In tumor site, the incidence of GI-NENs is highest in the rectum, followed by the stomach. In morphological type, the stomach is mainly ulcer type, and the rectum is mainly uplift type. In pathological types, gastric NENs is mainly neuroendocrine carcinoma, colorectal NENs is mainly neuroendocrine tumor. In pathological grading,gastric NENs belong to G3 mostly, colorectal NENs belong to G1 and G2 mostly. The prognosis of colorectal NENs is better than gastric NENs.3. The clinical manifestation of GI-NENs are mostly non functional, typicalcarcinoid syndrome is rarely seen clinically.4. The sensitivity of Syn is higher than that of Cg A and CD56. Cg A positive rate is related to tumor location, and the positive rate of Cg A in colorectal cancer is lower than that in the stomach and small intestine. Cg A in nearly half of the patients with colorectal NENs are negative, and that remind clinicians Cg A negative alone can not bindly rule out colorectal NENs, and we suggest that multiple immunohistochemical indicators should be combined in pathological examination.5. Using the nuclear fission image and Ki-67 index to conduct pathological grading of GI-NENs patients respectively, we find that there is a certain rate of non anastomosis in degree of classification. Ki-67 index is higher than 20% critical value(G3) and nuclear fission image classification for the G1 or G2 in some patients.We suggest that pathological examination and report should include the two results and to redivide the critical value of pathological grading standard to better guide clinical treatment.6. Surgical treatment is the main treatment of GI-NENs. Chemotherapy could not prolong the survival of patients with G3 in this study, this might be related to the number of cases with the study was too small, and part of patients lacked of the treatment cycle of chemotherapy.7. The survival of GI-NENs is related to age, tumor location, tumor size,vascular and nerve invasion, lymph node metastasis, distant metastasis, Ki-67 index,T stage, clinical stage and pathological classification. T stage, clinical stage and pathological classification are independent prognostic factors of GI-NENs. |
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