| Background: In recent years, the epidemiological studies in Europe and theUnited States showed the increasing trend of the incidence ofgastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), while in ourcountry cause there being no a nationwide cancer registry system, the currentepidemiology of GEP-NENs is unclear. Our study aimed to do a retrospectiveanalysis of the clinical features, treatments and prognosis of pancreaticneuroendocrine neoplasms (P-NENs) and rectal neuroendocrine neoplasms(R-NENs). We also assess the value of chromogranin A (CgA) in the preoperativediagnosis of P-NENs.Methods: This retrospective study included87P-NENs patients and74R-NENsreferred to Shanghai Ruijin Hospital for evaluation and follow-up between2003and2013. The medical histories and clinicopathological factors were collected.A total of193patients with pancreatic lesions diagnosed from2011to2014inShanghai Ruijin hospital were enrolled in the study. Serous CgA levels wereevaluated by ELISA preoperatively. The cutoff for diagnosis was identified byreceiver-operating characteristic (ROC) curve.Results:87patients with P-NENs were enrolled, in which55patients (63.22%) asfunctional,32patients(36.78%) as non-functional; neuroendocrine tumors(pathological type G1, G2)75(86.21%), neuroendocrine carcinoma (pathologicaltype G3)12(13.79%);67patients were TNM stage I;11were stage II; one patientwas stage III;6were stage IV. The stages of2patients were unclear.80patientsunderwent radical surgery. Gender, age, function of tumor and tumor size were notassociated with disease-free survival (DFS)(P>0.05). Grade and TNM stage werethe most significant predictors of DFS (P <0.05). 74patients with R-NENs were enrolled. There was no case of functional, and theclinical symptoms were non-specific. Endoscopic features were usuallysubmucosal polyp-like.66(89.19%) patients were WHO histological grade G1;6(8.11%)G2;2(2.7%) G3.58(78.38%) patients were TNM staging stage I;9(12.16%) were stage II;4(5,41%) were stage III;2(2.7%) were stage IV; one(1.35%) was unclear. Univariate analysis showed that lesion size impacted thedepth of invasion (P <0.05). Grade had no impact on the depth of invasion (P>0.05). Age, gender, tumor grade had no impact on the local lymph node metastasis(P>0.05). Tumor size, depth of invasion impact on the local lymph nodemetastasis (P <0.05).193patients were enrolled and serous CgA was tested. Postoperatively,63(32.64%) patients were diagnosed with P-NENs; the other130(67.36%) werenon-P-NENs, within which42were benign pancreatic disease, and88werepancreatic cancer. The median serous CgA level of P-NENs group was78.85ng/ml,which was higher than that of pancreatic cancer group (6.01ng/ml)(P<0.05) andbenign pancreatic disease group (5.472ng/ml)(P<0.05). ROC analysis identified acutoff of31.22ng/ml as discriminating between patients with P-NENs and withoutP-NENs (sensitivity100%; specificity90%). Grade had no impact on CgA levels(P>0.05).Conclusion: Insulinoma is the most common P-NENs. The clinical symptoms ofnon-functional P-NENs is no specific. Abdominal CT/MRI, pancreatic CT,pancreatic MRI, and CTA were more sensitive than abdominal B ultrasound indetecting the pancreatic lesions. Grade and TNM stage had no significant impacton DFS.Clinical symptoms of R-NENs were no specific. A considerable part of patients wasdiscovered incidentally within the examination of colonoscopy. The endoscopicfeatures of R-NENs were certain specific. The preoperative protocol for R-NENsneeded being standardized. Tumor size is a factor that influenced the depth oftumor invasion. Tumor size and depth of invasion were two important factorsaffecting regional lymph node metastasis. Serumal CgA had a value in differentiating P-NENs and other malignant andbenign pancreatic lesions, which might help to diagnosis P-NENs. The relationshipbetween grade and level of serous CgA needed to be explored further. |
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