| Objective:The present study retrospectively analyzed the clinical symptoms,pathological data and treatment methods of 140 patients with rectal neuroendocrine tumor in China-japan Union Hospital of Jilin University,and explored the correlation between tumor size and invasion level of lesions under endoscopic ultrasonography,providing reference for clinical diagnosis and treatment of rectal neuroendocrine tumor.Methods:Patients admitted to China-Japan Union Hospital of Jilin University from January 2016 to December 2021 who were pathologically diagnosed as R-NENS were collected and their clinical case data,including gender,age,pathology,immunohistochemistry and endoscopic ultrasonography,were retrospectively analyzed.The medical records of the patients were analyzed and summarized.SPSS25.0 statistical software was used for statistical analysis of the collected data.P < 0.05 was statistically significant.Results:There were 140 patients in this study,including 97 males（69.3%）and 43females（30,7%）,with a male to female ratio of 2.26:1.The age of onset is mainly between 50 and 60 years.The onset time ranged from 1 day to 20 years,and the median onset time was 1 month.The middle rectum had the highest incidence（55.7%）in 78 cases,followed by the lower rectum in 53 cases（37.9%）and the upper rectum in9 cases（6.4%）.The clinical symptoms were found in 45 cases（32.1%）,37 cases（26.4%）with changed defecation habit,33 cases（23.6%）with abdominal pain and distension,9 cases（6.4%）with diarrhea,9 cases（6.4%）with hematochezia,5 cases（3.6%）with changed stool behavior,and 2 cases（1.4%）with emaciation.According to tumor diameter,the tumor was divided into 3 groups: 1cm,≥1cm,< 2cm,≥2cm,the proportion of each group was 129 cases（92.1%,）11 cases（7.9%）,0,respectively.All 140 patients underwent surgical treatment.120 patients（85.7%）received endoscopic treatment,including 61 patients（43.6%）with EMR and 59patients（42.1%）with ESD.Surgical operation was performed in 20 cases（14.3%）.Neuroendocrine tumors were confirmed by postoperative pathology in all 140 patients.Among them,97 patients underwent immunohistochemical examination,including KI-67,Syn,Cg A,CD56 items.Ki-67 positive index ≤ 2%,3-20%,> 20% were divided into three groups,79 cases（82.5%）,18 cases（18.5%）,0.There was no statistical significance in the distribution of KI-67 positive index between males and females（P > 0.05）.There was statistical difference in ki-67 positive index between different tumor sizes（P < 0.05）,suggesting that the larger the tumor,the higher the KI-67 positive index,the more malignant the biological behavior.Ninety-five（97.9%）were Syn positive,57（58.8%）were CD56 positive,and 44（45.4%）were Cg A positive.The positive rate of Syn was significantly higher than that of Cg A and CD56.Syn positive rate was significantly higher than CD56 positive rate and Cg A positive rate（P < 0.001）,while CD56 positive rate was not significantly higher than Cg A positive rate（P > 0.05）.According to the positive ki-67 index,79 cases were G1,18 cases were G2,and no G3 patients,accounting for 82.5%,18.5%,and 0,respectively.Statistical analysis of the clinicopathological characteristics of R-Nens with different pathological grades showed that patients with different pathological grades had statistical differences in age,tumor size,Syn positive rate and surgical method.Conclusion:In the patient of rectum neuroendocrine tumor,male incidence of disease is higher than female,good hair place is middle lower section rectum.Endoscopic ultrasonography has guiding significance in the diagnosis and treatment of rectal neuroendocrine tumor.The sensitivity of Syn in immunohistochemistry was higher than that of Cg A and CD56,and Cg A was negative in nearly half of cases.Therefore,the diagnosis should be combined with multiple immunohistochemical indicators in pathological examination. |
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