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目的 分析胃肠胰神经内分泌瘤(GEP-NET)患者的临床病理特征,探讨影响其预后的危险因素.方法 回顾性分析2001年1月至2012年6月在四川省肿瘤医院入院治疗并经病理确诊为GEP-NET的68例患者资料,其中男52例,女16例；年龄35～77岁,平均年龄(57±11)岁.将患者的临床表现、病理特点、治疗及预后等信息作为GEP-NET患者预后的预测因素.运用Kaplan-Meier法计算患者的生存率,描绘不同预测因素水平患者的生存曲线.采用Log-rank法比较GEP-NET患者不同临床病理特征与预后的关系,采用多因素Cox回归分析筛选影响患者生存的独立危险因素.结果 68例GEP-NET患者的发病部位以胃体部(20例,29.41％)及贲门居多(16例,23.53％).男性患者好发于胃及贲门部位(34例,65.38％),女性患者好发部位多见于肠道(12例).不同部位GEP-NET患者的发病年龄之间差异有统计学意义(P=0.023),肠道NET的发病年龄最低,贲门部位最高.全部患者中位随访49(3～120)个月；随访期间37例(54.41％)患者死亡,其中因术后肿瘤复发30例.患者术后生存时间4～115个月,平均生存时间(46±7)个月,1、3、5年生存率分别为65.1％、41.5％、28.7％.单因素分析显示影响患者生存时间的危险因素为:患者年龄≥60岁、肿瘤大小＞2 cm、肿瘤临床分期处于T2～T4期、有血管浸润、有淋巴结转移、有远处转移、手术切缘阳性、病理类型为神经内分泌癌(NEC)及混合性腺神经内分泌癌(MANEC)(均P＜0.05).多因素分析显示:肿瘤大小＞2 cm、有远处转移、病理类型为NEC及MANEC是影响患者预后(生存时间)的独立危险因素.结论 GEP-NET可发生于消化系统的多个部位,临床表现无特异性.肿瘤大小、有无远处转移和病理类型是影响GEP-NET患者预后的独立危险因素.

Objective To analyze the clinicopathologic characteristics of gastroenteropancreatic neuroendocrine neoplasm (GEP-NET) and explore the prognostic factors for patients with GEP-NET.Methods Retrospectively reviews were conducted for the charts of 68 patients diagnosed pathologically with GEP-NET and treated at Sichuan Cancer Hospital during January 2001 to June 2012.The information of prognostic factors was retrieved and analyzed.Kaplan-Meier method was used to estimate survival rates and plot patient survival curves of patients at different levels of predictive factors.The association between clinicopathologic characteristic and prognosis in GEP-NET patients was assessed with Log-rank test.Meanwhile Cox proportional hazard model was used to select independent risk factors of patient survival.Results Stomach (20/68,29.41％)and cardia (16/68,23.53％) were mostly involved.Frequent tumor sites for males were stomach and cardia (34/52,65.38％) while the most common site was intestinal canal for female (12/16).Ages of disease onset were different significantly among patient groups of different sites (P =0.023).The average age of intestinal NET was the highest while gastric NET had the lowest.During a median follow-up duration of 49 (3-120) months,there were 37 deaths (54.41％),including 30 from postoperative relapses.Postoperative survival time ranged from 4-115 months.The mean survival periods were (46 ± 7) months respectively.The 1,3,and 5-year survival rates were 65.1％,41.5％ and 28.7％ respectively.Univariate analyses showed that the risk factors of survival time were patient age over 60 years,tumor size ＞ 2 cm,T2-4 stage of tumor,vascular invasion,lymph node metastasis,distant metastasis,positive surgical margin and pathological grades of neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine carcinoma (MANEC).Multivariate analysis indicated independent risk factors were tumor size ＞ 2 cm and pathological grades of NEC and MANEC.Conclusions GEP-NET may occur at multiple sites of digestive system and lack specific clinical manifestations.Tumor size,distant metastasis and pathological grades were independent prognostic factors for GEP-NET patients.