高分化直肠神经内分泌肿瘤的临床病理特征及预后分析

Clinicopathological characteristics and prognosis of well-differentiated rectal neuroendocrine tumor

摘要:

目的 探讨高分化直肠神经内分泌肿瘤（RNET）的临床病理特征及预后。方法 回顾性分析2017年8月－2021年12月在该院住院治疗的83例高分化RNET患者的临床资料，包括：临床表现、内镜检查、内镜下治疗、术后并发症、术后病理、随访情况和预后。以2019年世界卫生组织（WHO）确定的消化系统肿瘤分类为标准，根据病理分期，将83例患者分为G₁期组（72例）和G₂期组（11例）；根据患者瘤体数，将83例患者分为单发RNET组（77例）和多发RNET组（6例）；比较两种分组之间嗜铬粒蛋白A（CgA）、突触素（Syn）和CD56的表达情况。结果 根据病理结果分组时，G₁期组CgA阳性率明显高于G₂期组，差异有统计学意义（χ² = 4.23，P = 0.040）；根据瘤体数分组时，多发RNET组CgA阳性率明显高于单发RNET组，差异有统计学意义（χ² = 5.74，P = 0.017）；Syn和CD56在以上两种分组中比较，差异均无统计学意义（P > 0.05）。结论 高分化RNET常无特异性临床表现，多为单发直肠G₁期，ESD切除安全性高，预后良好，G₁期患者中CgA阳性率较高，多发RNET患者中CgA阳性率较高。

Abstract:

Objective To investigate the clinicopathological characteristics and prognosis of well-differentiated rectal neuroendocrine tumor (RNET).Methods A retrospective analysis was conducted using the clinical data from 83 patients with well-differentiated RNET from August 2017 to December 2021, including clinical manifestations, endoscopy, endoscopic treatment, postoperative complications, postoperative pathology, follow-up and prognosis. Pathological results according to the 2019 World Health Organization (WHO) Classification of digestive system tumors, 83 patients were divided into G₁ stage group (72 cases) and G₂ stage group (11 cases); Based on the number of tumors in the patient, 83 patients were divided into two groups: single RNET group (77 cases) and multiple RNET group (6 cases), the expressions of chromogranin A (CgA), synapsin (Syn) and CD56 were compared among different groups.Results Based on pathological findings in the group, G₁ stage group CgA positive rate was significantly higher than that of G₂ stage group, the difference was statistically significant (χ² = 4.23, P = 0.040); Based on the number of tumors, multiple RNET group CgA positive rate was significantly higher than that of single RNET group, the difference was statistically significant (χ² = 5.74, P = 0.017). It was no significant difference in Syn and CD56 between the two groups (P > 0.050).Conclusion Well-differentiated RNET has no specific clinical manifestations. It is mostly isolated in G₁ stage and single RNET. ESD is safe and has a good prognosis, the positive rate of CgA is higher in G₁ stage patients, and the positive rate of CgA is higher in patients with multiple RNET.