發(fā)布時間：2018-07-28 10:11

【摘要】：目的神經(jīng)內(nèi)分泌腫瘤(Neuroendocrine neoplasms)的患者早期臨床表現(xiàn)通常不典型,診斷不明確。當(dāng)腫瘤出現(xiàn)進(jìn)展或表現(xiàn)出癥狀時,確診不及時,治療方法不合理,患者預(yù)后較差。根據(jù)我院神經(jīng)內(nèi)分泌腫瘤的診治狀況,討論神經(jīng)內(nèi)分泌腫瘤的臨床特點、檢查項目、當(dāng)前的治療方案及預(yù)后生存因素。 方法收集并分析蘭大一院在2011年1月至2013年6月底收治的42例神經(jīng)內(nèi)分泌腫瘤患者的臨床資料、實驗室病理檢查和影像學(xué)資料,及給予的治療方法。分析不同臨床特征分組的患者生存情況(中位生存期和2年生存率),總結(jié)臨床診治經(jīng)驗,探討影響該疾病預(yù)后的相關(guān)因素。 結(jié)果共收集42例神經(jīng)內(nèi)分泌腫瘤的病例,其中男性32例,女性10例,年齡從17歲至79歲,中位年齡59歲。胃腸道胰腺系統(tǒng)的神經(jīng)內(nèi)分泌腫瘤病例有20例,支氣管肺系統(tǒng)的病例有11例,其他部位有11例,診斷時出現(xiàn)轉(zhuǎn)移灶的病例有22例。免疫組化檢測腫瘤標(biāo)記物突觸素、嗜鉻粒蛋白、上皮膜抗原,將三種指標(biāo)進(jìn)行非參數(shù)檢驗統(tǒng)計比較,結(jié)果P0.05提示差異有統(tǒng)計學(xué)意義,EMA陽性率較其他兩組低。至2014年1月失訪病例有12例,隨訪時間為0-34個月,中位時間13.5個月。全部病例進(jìn)行TNM分期,分組為Ⅱ、Ⅲ和Ⅳ期患者的2年生存率分別是68.6%、56.3%和26.3%。根據(jù)Ki-67增殖指數(shù)進(jìn)行病理分級為未報告組、G1-2組、G3級,患者的2年生存率分別是41.5%、100%和35.5%。不同TNM分期和病理分級的患者生存率比較無統(tǒng)計學(xué)意義。全部病例的中位生存期為19個月。轉(zhuǎn)移組22例與非轉(zhuǎn)移組20例,2年生存率分別是28.5%、68.8%,轉(zhuǎn)移組中位生存期15個月。手術(shù)治療組26例和非手術(shù)治療組16例患者2年生存率分別是71.2%和0,非手術(shù)組中位生存期12個月。胃腸道部位腫瘤患者20例中位生存期為19個月,2年生存率44.2%,支氣管肺部位11例中位生存期為11個月,2年生存率0,腫瘤位于其他部位病例11例2年生存率88.9%。單因素分析顯示是否手術(shù)、不同部位及病灶是否轉(zhuǎn)移對患者生存期有影響,生存率比較差異有統(tǒng)計學(xué)意義(Log-Rank檢驗均有P0.05). Cox多因素分析顯示手術(shù)為影響生存期的獨立因素。 結(jié)論1.手術(shù)切除可明顯改善該疾病患者的生存期。2.不同部位的神經(jīng)內(nèi)分泌腫瘤的患者生存期存在差異,出現(xiàn)轉(zhuǎn)移灶的患者生存期較短。
[Abstract]:Objective the early clinical manifestation of neuroendocrine tumor (Neuroendocrine neoplasms) is usually atypical and the diagnosis is not clear. When the tumor develops or shows symptoms, the diagnosis is not timely, the treatment is unreasonable, and the prognosis of the patients is poor. According to the diagnosis and treatment of neuroendocrine tumors in our hospital, the clinical features, examination items, current treatment plans and prognostic survival factors of neuroendocrine tumors were discussed. Methods the clinical data, laboratory pathological examination and imaging data of 42 patients with neuroendocrine neoplasms from January 2011 to June 2013 were collected and analyzed. The survival conditions (median survival time and 2-year survival rate) of patients with different clinical characteristics were analyzed. The clinical experience was summarized and the related factors affecting the prognosis of the disease were discussed. Results A total of 42 cases of neuroendocrine tumors were collected, including 32 males and 10 females, ranging in age from 17 to 79 years, with a median age of 59 years. There were 20 cases of neuroendocrine tumors in the gastrointestinal and pancreatic system, 11 cases of bronchopulmonary system, 11 cases of other parts, and 22 cases of metastases at the time of diagnosis. Immunohistochemical detection of tumor markers synaptophysin, chromaffin, epithelial membrane antigen, the three indicators of non-parametric test statistical comparison, the results showed that there was significant difference between the two groups in EMA positive rate was lower than the other two groups. Up to January 2014, there were 12 cases of lost visit, the follow-up time was 0-34 months, the median time was 13. 5 months. The 2-year survival rates of patients with stage 鈪，

本文編號：2149753