| Objective: We retrospectively analyzed the clinical features of 222 cases of gastroenteropancreatic neuroendocfine neoplasm(GEP-NENs)in the First Hospital,the Second Hospital and discussed the related factors affecting the prognosis of GEP-NENs.Methods: Include 222 cases of complete GEP-NENs patients admitted from January 2009 to September 2015 at the First Hospital of Jilin University,the Second Hospital.All cases were diagnosed and classified according to histopathological examination.To follow-up by outpatient,hospital review and telephone consultation.(1)according to the median age(52 years)will be divided into two groups: <52 years old,≥52 years old;(2)according to the tumor diameter is divided into three groups: <1cm,1 ~ 2cm,> 2cm;(3)According to the tumor site is divided into six groups: Stomach NENs,small intestine NENs,colon NENs,rectal NENs,appendix NENs,pancreas NENs;(4)according to the treatment method is divided into six groups: Endoscopic interventional therapy(including EMR,ESD,TEM),laparoscopy,surgery,symptomatic treatment,radiotherapy and chemotherapy,and other.To compare the survival time of patients with sex,age,tumor size,clinical symptoms,tumor location,tumor grade,CgA positive rate,Syn positive rate,Ki-67 positive index,treatment and other aspects of relevance,At the same time,the factors related to prognosis were analyzed.Count data or partial composition ratio comparison using chi-square test,part of the chi-square test conditions do not meet the data analysis using Fisher exact test method.Kaplan-Meier method was used to evaluate the survival rate of patients,and the survival curves were compared by Log-rank test.All the statistical results were P <0.05 for the difference was statistically significant.Results: 222 cases of male 125 cases,97 cases of women,male to female ratio of 1.29: 1.The age of men and women mainly concentrated in the 35 to 64 years old.There were no significant differences in age distribution among the sexes(P> 0.05).The incidence of tumor was most common in rectum(160 cases),followed by pancreas(23 cases),appendix(16 cases),stomach(12 cases),small intestine(5 cases)and colon(6 cases).Mainly showed non-specific gastrointestinal symptoms(such as abdominal pain,abdominal distension,acid reflux,etc.),only 5 cases showed carcinoid syndrome(such as diffuse flushing,secretory diarrhea,dyspnea,etc.).Among the 222 patients,172 cases were found by gastrointestinal examination,27 cases were CT,9 cases were found in abdominal color Doppler ultrasound,9 cases were found in operation,4 cases were found in rectal examination,1 case was MRI.The treatment was mainly treated by surgery(52 cases),endoscopic interventional therapy(143 cases,including 55 cases of EMR,43 cases of ESD,45 cases of TEM),laparoscopic(15 cases),interventional therapy(3 cases)And biotherapy(2 cases),symptomatic treatment(6 cases).According to the largest diameter of the tumor is divided into three groups,namely <1cm,1 ~ 2cm,> 2cm,the number of cases was 162 cases,30 cases and 30 cases respectively.The proportion was 72.98%,13.51% and 13.51% respectively.Ki-67 positive index was divided into three groups according to ≤2%,3~20%,>20%,the number of cases in each group was 179 cases,22 cases,10 cases,the percentage was 84.83%,10.43%,4.74%.The results showed that the stomach,colon,rectum,pancreas and appendix NENs showed more ki-67≤2%,and the small intestine NENs showed more ki-67> 20%.The positive rate of ki-67 in different tumor patients was different,and the difference was statistically significant(P <0.05).Immunohistochemical analysis: CgA positive in 160 cases(99 males and 61 females),negative in 62 cases(26 males and 36 cases),the positive rate was 72.07%.According to the statistics,the positive rates of CgA in the stomach,small intestine,colon,rectum,appendix and pancreas NENs were 100%,100%,100%,62.50%,93.75% and 95.65% respectively.The difference of CgA positive rate between the two sexes was statistically significant(P <0.05).Syn positive 221 cases(125 males and 96 females),negative in 1 case(male 0 cases,female 1 case),the positive rate was 99.55%.According to the statistics,the positive rates of stomach,small intestine,colon,rectum,appendix and pancreas NENs were 100%,100%,100%,100%,100% and 95.65% respectively.There was no significant difference in the positive rate of patients with sex between the two sexes(P> 0.05).The positive rate of CgA was significantly lower than that of Syn,the difference between them was statistically significant,that is,CgA was lower than Syn sensitivity(P <0.05).The tumors were sacrificed in 222 patients,G1 187 cases,G2 17 cases,G3 18 cases,the proportion of each level were 84.23%,7.66%,8.11%.There were significant differences in tumorigenesis,tumor size and Syn positive rate between different grading patients(P <0.05).Age,tumor location,tumor size,CgA positive rate,ki67 positive index,distant metastasis,tumor grade,different treatment regimen,the survival rate of patients was different,the difference was statistically significant(P <0.05),While sex,Syn positive rate and patient survival rate,the difference was not statistically significant(P> 0.05).Gender was different,the survival rate of patients was different,male slightly higher than women,but the difference was not statistically significant(P> 0.05).According to the median age of patients,it was divided into ≥52 years old and <52 years old group,different age groups,the survival rate is different(P <0.05).The survival rate of patients with different tumor location,the difference was statistically significant(P <0.05).Tumor grade is different,the survival rate is different(P <0.05).The survival rate of patients with different tumor size was different,the difference was statistically significant(P <0.05).CgA positive rate and Syn positive rate could affect the survival rate(P <0.05).The positive rate of ki-67 was different,the survival rate of patients was different,the difference was statistically significant(P <0.05).Different treatment methods,the survival rate of patients is also different,the difference was statistically significant(P <0.05).Whether the tumor metastasis of patients with distant,will seriously affect their survival rate,the difference is also statistically significant(P <0.05).Conclusion:(1)aged 35 to 64 years of age,abdominal pain,for no apparent reason,and bloating,changes in bowel habits,should be actively row gastrointestinal endoscopy to rule out the existence of early GI-NENs.(2)GI-NENs preferred treatment for non-distant metastases were endoscopic interventional therapy.(3)In order to improve early diagnosis of pancreas and small intestine NENs abdomen except for gastrointestinal diseases caused by discomfort,as soon as possible to improve abdominal CT. |
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