Clinicopathological characteristics of 83 lymph node-negative rectal neuroendocrine tumors
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摘要:
目的 探讨淋巴结阴性直肠神经内分泌肿瘤（rectal neuroendocrine neoplasms，R-NENs）的临床病理特征。 方法 回顾性分析2012年12月至2019年12月中日友好医院83例淋巴结阴性R-NENs患者的临床病理资料，并定期随访。 结果 83例患者中男性49例（59.0%）、女性34例（41.0%）；平均年龄（43.3±11.4）岁；61例（75.5%）患者主要因非特异性症状就诊；肿瘤单发75例（90.4%）；肿瘤平均直径为（0.8±0.7）cm；主要浸润黏膜层及黏膜下层80例（96.4%）；病理分级以G1为主，共65例（78.3%），Ki-67指数平均值为（2.1±1.7）%；肿瘤分期Ⅰ期78例（94.0%）。免疫组织化学法检测CgA阳性29例（34.9%）。治疗方式使用内镜下切除67例（80.7%），手术16例（19.3%）。中位随访时间24（3~90）个月，5年生存率100%，2例（2.4%）复发。肿瘤复发与Ki-67阳性指数具有显著相关性（P=0.025）；肿瘤浸润深度与肿瘤直径具有相关性（P=0.030）。Kaplan-Meier法分析得出治疗方式、肿瘤分级对预后复发的差异具有统计学意义（P=0.031、0.001）。 结论 淋巴结阴性R-NENs直径>1.0 cm相对容易浸及固有肌层，直径≤ 1.0 cm也有浸及固有肌层的可能，建议此类患者行超声内镜（EUS）检查以决定治疗方式。内镜下切除为淋巴结阴性R-NENs的主要治疗方式，Ki-67指数较高患者治疗后相对容易复发。 Abstract:Objective To explore the clinicopathological characteristics of lymph node-negative rectal neuroendocrine neoplasms (RNENs). Methods We retrospectively analyzed and regularly followed up the clinical and pathological data of 83 patients with lymph node-negative rectal NENs treated at China-Japan Friendship Hospital between December 2012 to December 2019. Results Among the 83 patients, 49 (59%) were male and 34 (41%) were female with an average age of (43.3±11.4) years. Of the patients, 61 (75.5%) were mainly treated for nonspecific symptoms, 75 (90.4%) had a single tumor with an average size of (0.8±0.7) cm, 80 (96.4%) showed tumor infiltration into the mucosal and submucosal layers, and 65 (78.3%) predominantly had tumors of pathological grade G1. The average Ki-67 index was (2.1±1.7)%, with 78 (94%) patients having stage I tumors. Twenty-nine (34.9%) patients showed CgA positivity on immunohistochemical analysis. As for treatment, 67 (80.7%) patients underwent endoscopic resection, and 16 (19.3%) patients underwent surgery. The median follow-up time was 24 (3-90) months, with a 100% 5-year survival rate and relapse in 2 (2.4%) patients. Tumor recurrence was significantly correlated with the Ki-67 positive index (P=0.025), and tumor infiltration depth was correlated with the tumor diameter (P=0.03). Kaplan-Meier analysis showed that different treatment mode and tumor grade on prognosis and recurrence was statistically significant (Log-rank P=0.031, 0.001). Conclusion Lymph node-negative rectal neuroendocrine neoplasms with a diameter >1 cm infiltrate the muscularis propria relatively easily and those ≤ 1 cm may also infiltrate the muscularis propria. It is recommended that all patients undergo ultrasound enteroscope (EUS) to determine the treatment choice. Endoscopic resection is the main treatment for lymph node-negative rectal neuroendocrine neoplasms. Patients with a high Ki-67 index are relatively prone to relapse after treatment. -
图 1 R-NENs超声内镜下表现
A：电子肠镜：距肛门5 cm处可见一直径约1.0 cm的隆起病变，表面尚光滑；B：超声内镜：病变位于黏膜及黏膜肌层的稍低回声结节，大小0.7 cm×0.5 cm，黏膜下层及固有肌层完整连续
图 2 R-NENs的病理学特征
A：1例淋巴结阴性R-NENs G1患者（H&E×400），可见肿瘤细胞排列呈梁索状；B：免疫组织化学染色肿瘤细胞CgA阳性（IHC×400）；C：免疫组织化学染色肿瘤细胞Ki-67为1%（IHC×400）；D：免疫组织化学染色肿瘤细胞SSTR2阳性（IHC×400）
表 1 83例淋巴结阴性R-NENs患者临床病理特征
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