| Objective:Neuroendocrine neoplasms(NENs)which originate from the neuroendocrine cells are capable of secreting neuropeptides and hormones.Due to the difference of proliferative activity and mitotic image,NENs behave a wide range of malignant potential,from benign to poorly differentiated tumors.Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs)which secret serotonin metabolites or polypeptide hormonesmainly is the most commonly affected site(about 65%-75%).With the development of endoscopy and biomarkers,the incidence of GEP-NENs is increasing year by year.This research aims to summarize and analyze the clinical features,pathological characteristics,diagnostic methods,treatment modalities and prognosis of gastroenteropancreatic neuroendocrine tumors(GEP-NENs),to explore the prognostic factors for them and provide a reference basis for predicting clinical outcome of the disease.Materials and methods:Totally 355 patients with GEP-NENs in the Fourth Hospital of Hebei Medical University from April 2006 to November2017 were analyzed retrospectively.The clinical features,pathological characteristics,diagnostic methods and treatment modalities were regarded as predictors of survival.The main end point was overall survival(OS)and progression-free survival time(PFS).Data were exported to SPSS 17.0.Kaplan-Meier survival curve was used to estimate the mean survival time or median survival time.In univariate analysis,survival time was compared by Log-rank test.Multivariate Cox-proportional hazard model was employed to identify predictors of survival outcomes.Results:1.Clinical featuresThe number of confirmed cases per year increased from 1 case in 2006 to95 cases in 2017.Among the 355 patients with GEP-NENs,228(64.23%)were men and 127(35.77%)were women;the male to female ratio was 2.27:1.Ages ranged from 22 to 75 years,and the median age was 60 years.The most common tumor site was the stomach 48.17%(171/355),followed by the pancreas 16.06%(57/355),colorectal 14.08%(50/355),esophagus7.61%(27/355),duodenum and jejunum 5.63%(20/355),liver 4.23%(15/355),appendix 2.25%(8/355),gallbladder and bile duct 2.25%(7/355).The most frequent initial presentation was abdominal pain(88/350,25.14%),followed by ventosity(77/350,22.00%),examination(68/350,19.43%).4 cases were diagnosed as islet cell tumors behaving hypoglycemia syndrome.295 cases were treated surgically,including 45 cases of endoscopic resection,250 cases of traditional operation and 60 cases of non-operative treatment.2.Histopathologic characteristicsThe maximum diameter of tumor was 4.07±3 cm.According to the current WHO 2010 criteria,22.53%(80/355)were reclassified as NEN grade1(G1),while 12.68%(45/355)were NEN grade 2(G2),and 58.87%(209/355)were NEC grade 3.The stage of tumor were stageⅠ14.65%(52/355),stageⅡ26.48%(94/355),stageⅢ26.76%(95/355)and stageⅣ6.49%(23/355).Immunohistochemical staining showed an 79.67%positive rate for chromogranin A and an 97.93%positive rate for synaptophysin.3.Risk factor analysisThe median follow-up time was 34 months and the success rate of follow-up was 94.37%.The mean survival time was 73.73±4.92 months(95%CI:64.08-83.38)and the median survival time was 79 months.The estimated 1-、3-and 5-year overall survival rates for all patients were 80.1%、59.8%and 57.5%.The mean relapse-free survival time was 59.94±5.52months(95%CI:49.11-70.76)and the median PFS was 42 months.The 1-、3-and 5-year relapse-free survival rate were 68.7%、54.9%、50.0%.Univariate analysis confirmed that patients with the body mass index(BMI),non-operative group,palliative resection,tumor site in gallbladder,tumor invading the subserous layer,stageⅣ,grade G3,vein tumor embolus,lymph node metastasis,plasma albumin<40g/L,the maximum diameter of tumor>2cm,and leukomonocyte<1.1×10~6/L,negative for Syn,positive for NSE and negative for vim were risk factors for prognosis.Multivariate analysis of the above factors showed that treatment,radical operation,depth of tumor infiltration,stage,grade,vascular embolus,status of lymph node metastasis and tumor diameter were the most significant predictors of survival.However,there was no significant difference in plasma albumin level,body mass index(BMI),primary tumor site,preoperative lymphocyte count and NES,Vim.Conclusion:1.The incidence of gep-nens is increasing year by year.2.The incidence of gep-nens in males is more than that in females in this study.3.The most common site of GEP-NENs was the stomach,followed by the pancreas,colorectal.4.The clinical manifestations of non-functional GEP-NENs were not specific.The most common type of functional GEP-NENs was insulinoma,which behaved paroxysmal hypoglycemia.5.The treatment of GEP-NENs is a comprehensive treatment based on surgery,and endoscopic resection is still recommended for GEP-NENs with a small size,involving the mucus,and no metastasis.6.With other malignant tumors of the digestive tract,the onset of GEP-NENs is hidden,and the clinical manifestations are atypical.About 80%of the patients are advanced or advanced at the time of diagnosis.7.The mean OS of GEP-NENs in this study was 73.73±4.92 months.The5-year survival rate was 57.5%,mean PFS 59.94±5.52 months,5-year recurrence-free survival rate:50.0%.GEP-NENs is still a kind of tumor with higher malignant degree.It is important to improve the prognosis by improving the early detection rate and standardized treatment of the tumor.8.The independent prognostic factors of GEP-NENs were the treatment method,the degree of radical operation,the depth of tumor invasion,tnm stage,grade,vascular tumor thrombus,lymph node metastasis and tumor size.We also need to further improve the tumor registration system of GEP-NENs,which has important value in guiding clinical treatment. |
