86例胃神经内分泌肿瘤临床病理特点及预后分析

Clinicopathological Characteristics and Survival Prognosis of 86 Cases of Gastric Neuroendocrine Neoplasms

摘要: 目的：分析86例胃神经内分泌肿瘤的临床病理特征及生存预后，进一步提高对此病的认识。方法：回顾性分析安徽医科大学第二附属医院2015年1月~2023年9月收治的86例经病理学诊断为G-NENs的患者临床及随访资料，使用Log-Rank检验进行单因素分析计算存活率；采用Cox比例风险回归模型进行多因素分析筛选影响其预后的危险因素。结果：86例G-NENs患者中，男63例(73.3%)，女23例(26.7%)，临床表现均为消化道一般症状，其中最常见的症状是腹痛腹胀29例(33.7%)。病理类型中G1级5例(5.8%)，G2级3例(3.5%)，G3级19例(22.1%)，NEC 15例(17.4%)，MINEN 44例(51.2%)。其中，嗜铬粒蛋白A (CgA)阳性率68.6% (59/86)，突触素(Syn)阳性率97.7% (84/86)，CD56阳性率为74.4% (64/86)，其中5例(5.8%)患者Ki-67指数 < 3%，14例(16.3%)患者Ki-67指数在3%~20%之间，67例(77.9%)患者Ki-67指数 > 20%。COX回归分析显示，病理分级、Ki-67指数、远处转移是G-NENs患者预后不良的独立危险因素。结论：G-NENs的生存受到较多因素的影响，治疗以手术为主。建议早期筛查并积极早期手术，针对MiNEN (占比51.2%)探索靶向/免疫联合治疗策略。以推进治疗方案的进一步发展。诊治过程中应加强对各因素的管理，提高患者生存率与生存质量。

Abstract: Objective: To analyze the clinicopathological characteristics and survival prognosis of 86 cases of gastric neuroendocrine neoplasms (G-NENs) and further improve understanding of this disease. Methods: A retrospective analysis was conducted on clinical and follow-up data of 86 patients diagnosed with G-NENs by histopathology at the Second Affiliated Hospital of Anhui Medical University between January 2015 and September 2023. The Log-Rank test was used for univariate analysis to calculate survival rates, and the Cox proportional hazards regression model was applied for multivariate analysis to identify risk factors affecting prognosis. Results: Among the 86 G-NENs patients, 63 were male (73.3%) and 23 were female (26.7%). Clinical manifestations were nonspecific gastrointestinal symptoms, with the most common being abdominal pain and bloating (29 cases, 33.7%). Pathological grading included G1 in 5 cases (5.8%), G2 in 3 cases (3.5%), G3 in 19 cases (22.1%), neuroendocrine carcinoma (NEC) in 15 cases (17.4%), and mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) in 44 cases (51.2%). Immunohistochemical analysis revealed positive rates of 68.6% (59/86) for chromogranin A (CgA), 97.7% (84/86) for synaptophysin (Syn), and 74.4% (64/86) for CD56. 5 patients (5.8%) had a Ki-67 index of <3%, 14 patients (16.3%) had a Ki-67 index between 3% and 20%, and 67 patients (77.9%) had a Ki-67 index of >20%. Cox regression analysis identified pathological grade, Ki-67 index and distant metastasis as independent risk factors for poor prognosis in G-NENs patients. Conclusion: The survival of G-NENs patients is influenced by multiple factors, with surgery remaining the primary treatment. Early screening and prompt surgical intervention are recommended, while exploring targeted or immunotherapy strategies for MiNEN (accounting for 51.2%) to advance treatment development. Management of these factors during diagnosis and treatment should be emphasized to improve patient survival and quality of life.