| Objective: By analyzing the clinical manifestations,pathological types,disease characteristics,immunohistochemistry,and prognosis of gastric neuroendocrine carcinomas(including gastric mixed gonadal-neuroendocrine carcinomas),various factors and different types of gastric neuroendocrine carcinomas were explored and analyzed.The connection between various factors.Methods: In strict accordance with the criteria for inclusion and exclusion,the clinical data of 223 patients with gastric neuroendocrine carcinoma(including gastric mixed glandular-neuroendocrine carcinoma)admitted from November 2009 to June 2016 in Shanxi Cancer Hospital were retrospectively analyzed.Complete data of 73 patients with complete data,detailed diagnosis and treatment records,relevant examinations,laboratory tests,etc.to meet the content of the study,statistical data on patients with gastric neuroendocrine carcinoma,gender,age,onset time,complaints,and disease progression,admission and discharge diagnosis,diagnosis and treatment,clinical symptoms,detailed imaging examination data,pathological biopsy data,including AE1/AE3,Ki67,Syn,CGA,CDX2,CD56 and other indicators and pathological biopsy lymphatic metastasis,retinal metastasis,Vascular metastasis,neural invasion,etc.Gastric neuroendocrine carcinoma detailed TNM staging,tumor site,size,specific treatment conditions after admission,including surgery,radiochemotherapy,and other symptomatic supportive care,postoperative and placement Post-chemotherapy related laboratory tests,inspections,review and other indicators.The patient was followed up and the patient's condition was recorded after discharge.The patient's death time,age,cause of death,post-discharge complications,and tumor metastasis were recorded in detail.The related statistical analysis was used to compare the clinical data and the influencing factors of prognosis of patients with gastric endocrine carcinoma.Results: 1.Among the enrolled patients,there were 58 males,accounting for 79.45% of the total,and 15 females,accounting for 20.55% of the total.The male to female ratio was 3.81:1.The age of 31-82 years old,the average age of 60.25 years old,of which the age of onset of men and women are concentrated between 50-69 years old.A total of 52 patients in this age group accounted for 71.23% of the total,including 40 male patients,accounting for 54.79% of the total,12 female patients,accounting for 45.21% of the total.The proportion of males was higher than that of females,but it was not statistically significant(P>0.05).2.Of the 73 cases of gastric neuroendocrine carcinoma,33(45.21%)were located in the cardia,22 cases(30.14%)in the corpus,18 cases(24.65%)in the pylorus,and the incidence of cardia was the highest,including 29 cases(87.88%).4 cases(12.12%)were females;the incidence of corpus was second,including 15 males(68.18%)and 7 females(31.82%);the incidence of pylorus was lower,including 14 males(77.78%),4 females(22.22%).The proportion of males at each site of incidence was higher than that of females,but it was not statistically significant(P>0.05).3.The first symptoms of patients with different primary sites are different.There were 72 patients with non-functioning gastric neuroendocrine carcinoma,manifested as local symptoms caused by tumor growth(such as abdominal pain,epigastric discomfort,eating difficulties,nausea and vomiting,etc.),and systemic symptoms(such as fatigue,wasting,etc.)caused by tumor activity;Only one patient had functional gastric neuroendocrine cancer traits,manifested as diarrhea symptoms in the carcinoid syndrome.4.The shape and size of tumors were varied.Patients undergoing gastric cancer resection were based on postoperative pathological examination.Patients who did not undergo surgical treatment were examined by endoscopy and imaging.There were 64 cases(87.67%)of ulcers,4 cases of infiltration(5.47%),and 5 cases of nodules(6.65%).Twenty-five patients with tumors larger than 2cm*2cm and 18 patients with tumors less than 2cm*2cm.5.The vasculature and nerve invasion of tumors were mainly pathological reports.There were only 23 cases with vascular invasion(31.51%),only 4 cases with nerve invasion(5.47%),and 22 cases with vascular and nerve invasion(30.14%).Invasive vascular nerves in 14 cases(19.18%).6.Tumor retinal and lymphatic metastases were mainly pathological reports.There were only 23 cases(31.51%)with retinal metastases,52 cases(71.23%)with lymph node metastases only,and 6 cases(8.22%)with omental and lymph node metastases.No retinal and lymphatic metastasis occurred in 2 cases(2.74%).7.According to 2010 WHO Gastric Neuroendocrine Tumor TNM staging criteria,0,1 and 2 each in 1 case,3 in 39 cases,and 4 in 31 cases,based on the depth of tumor invasion T stage: Tis period(In situ carcinoma(1 case),T1 stage(tumor invading mucosa lamina propria or subserous layer)in 1 case,T2 stage(tumor invading muscle layer)in 2 cases,T3 stage(tumor invading serosal layer)in 27 cases,T4 stage(tumor Infringement)36 cases,Tx period(cannot be assessed)6 cases.According to regional lymph node metastasis,N stage: N0 stage(no regional lymph node metastasis)in 15 cases,N1 stage(1 to 2 regional lymph node metastases)in 21 cases,N2 stage(1 to 2 regional lymph node metastases)in 12 cases,N3 Stage(3 or more regional lymph node metastases)in 17 cases.Nx(regional lymph nodes could not be evaluated)in 7 cases.M staging based on the presence or absence of distant metastases in the tumor: M0 phase(no distant metastasis)46 cases,M1 phase(distant metastasis)27 cases.Among them,liver metastasis was the most(13/27).It can be seen that when a patient with gastric neuroendocrine carcinoma is treated,bloody liver metastases are most common.8.According to the WHO classification of pathological criteria for gastric cancer in 2010,73 patients were divided into G-NECs and G-MANECs,of which 47 were G-NECs(64.38%),of which 21 were cardiac cancer,15 were gastric cancer,and 17 were pyloric cancer.example.There were 26 cases(35.62%)of G-MANECs,including 12 cases of cardiac cancer,8 cases of gastric body cancer,and 7 cases of pyloric cancer.9.Of the 73 cases,67(91.78%)were positive for AE1/AE3,6(8.22%)were negative,40(57.79%)were positive for CAM5.2,33(45.21)were negative,and 20(27.40%)were positive for CDX2.),Negative in 53 cases(72.60%);Syn positive in 67 cases(91.78%),negative in 6 cases(8.22%);CGA positive in 48 cases(56.75%),negative in 25 cases(34.25%);Ki67 more than 20% in 59 cases(80.82%),less than 20% in 14 cases(19.18%);CD56 positive in 22 cases(30.14%)and negative in 51 cases(69.86%).Of the 47 NECs,42 were positive for AE1/AE3,5 were negative,21 were positive for CAM5.2,26 were negative,13 were positive for CDX2,34 were negative,41 were positive for Syn,6 were negative,31 were negative for CGA,and negative.In 16 cases,Ki67 was more than 20% in 38 cases,less than 20% in 9 cases;CD56 was positive in 10 cases and negative in 37 cases.Among the 26 patients with MANECs,23 were positive for AE1/AE3,2 were negative,20 were positive for CAM5.2,6 were negative,7 were positive for CDX2,19 were negative;26 were positive for Syn,and 0 were negative;17 were negative for CGA,negative In 9 cases,Ki67 was greater than 20% in 20 cases,less than 20% in 0 cases,CD56 in 13 cases,and negative in 2 cases in 13 cases.The positive rate of CAM5.2 and CD56 was related to the pathological classification of G-NECs.The positive rate of CAM5.2 and CD56 in MANECs was higher than that of NECs,which was statistically significant.10.Of the 73 patients with gastric neuroendocrine carcinoma,37 were treated with surgery alone,19 were treated with surgery plus postoperative chemotherapy,1 was treated with neoadjuvant chemotherapy,1 was treated with postoperative radiochemotherapy,and 10 were treated with chemotherapy alone.One case was treated and two cases were given up.Among all surgical patients,there were 10 cases of type I surgery,6 cases of type 2 surgery,33 cases of R-Y type operation,5 cases of palliative operation,and 5 cases of extensive radical operation.There were 53 cases of laparotomy and 5 cases of laparoscopic surgery.Of all the 31 patients undergoing chemotherapy,19 underwent postoperative chemotherapy,10 underwent palliative chemotherapy,1 under neoadjuvant chemotherapy,and 1 underwent postoperative radiochemotherapy.The main chemotherapy regimens include the cisplatin and etoposide regimens,the oxaliplatin capecitabine regimen,the oxaliplatin stegio regimen,the oxaliplatin leucovorin 5-fluorouracil regimen,and more.There was only one case of radiotherapy treatment.The specific radiotherapy was: right upper quadrant metastasis lesions anterior mediastinum metastasis lesions cervical metastatic lesions totaling DT: 60GY/30 times/43 days.11.All 73 patients were followed up until March 16,2018.Of the 73 patients,17 were still alive and 56 had died.Three patients died during hospitalization due to multiple organ failure,one patient died of multiple organ failure the day after discharge,and 52 patients died of tumor metastasis within one month to three years after discharge.disease.The survival of patients with gastric neuroendocrine carcinoma is affected by multiple factors.The study found that Ki67 index and treatment method had an impact on the survival of patients(P <0.05),gender,age,tumor site,tumor size,Syn positive rate,CGA positive rate,whether There were no statistically significant differences(P>0.05)between lymph node metastasis,vascular infiltration,retinal metastasis,and neurological invasion.Conclusion: 1.Gastric neuroendocrine carcinomas can develop at all ages,with a significant increase after age 50 and concentration in 50-70 years.2.The symptoms and signs of patients with gastric neuroendocrine carcinoma are mostly atypical,mostly non-functional symptoms.Some patients with neuroendocrine tumors may present with clinical symptoms of carcinoid syndrome,but the proportion is very low.3.Patients with gastric neuroendocrine carcinoma are treated with surgery.Even palliative surgery has significant significance in prolonging the survival and quality of life of patients with gastric neuroendocrine carcinoma.The chemotherapy regimen for gastric neuroendocrine cancer is unclear,and there is no difference between the chemotherapy regimen for gastrointestinal adenocarcinoma and the effect after chemotherapy remains to be verified.Clinical application of radiotherapy for patients with gastric neuroendocrine carcinoma is rare and lacks large sample studies.4.The prognosis of patients with gastric neuroendocrine carcinoma is not affected by age,gender,location of the disease,pathological type of tumor,clinical symptoms and other factors,Ki67 positive index can affect the survival rate of patients. |
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