Screening Of Metastasis Related Factors On Gastroenteropancreatic Neuroendocrine Tumors

Objective:To find metastasis related factors on gastroenteropancreatic neuroendocrine tumors(GEP-NETs) and provided with early alarms and prognostic basis for the metastasis of GEP-NETs by retrospectively analyzing the clinical data, Endoscopic data, Pathological data and Lymphatic vessel density(LVD).Methods:A total of124patients who are diagnosed as the GEP-NETs during January2001to January2013in Second Xiangya Hospital of Central South University, all specimens from endoscopic resection or surgery. According to the GEP-NETs TNM staging of WHO2010(including stomach, small intestine, pancreas, appendix, colorectal NET, liver NET reference to the other kinds of liver carcinoma TNM staging), phase0, I belong to Without Metastasis Group and phase II, III,IV belong to Metastasis group.Analysed the relationship between the clinical data, Endoscopic data, Pathological data, Lymphatic vessel density (LVD) and the GEP-NETs metastasis by SPSS17.0.Results:1.Clinical data:male84and female40, average age49.26±13.31years.;The most common non-specificity symptoms are abdominal pain(64.51%), stool changes(39.52%),melena(21.77%); The most common sites of GEP-NETs are the rectal(58.9%), gastric(13.7%), small intestine(9.7%).Gender, age, abdominal pain and the tumor primary site, all of these factors have no significant difference between the metastasis group and without metastasis group by chi-square test and Logistic regression(P>0.05). Stool changes and melena have significant difference between the metastasis group and without metastasis group by chi-square test (P<0.05) while not by Logistic regression(P>0.05).2. The endoscopic findings of GEP-NETs:the maximum diameter of tumor17cm,minimum diameter0.2cm. There are16cases multiple GEP-NETs,4of them are metastasis. There are no significant difference between sporadic group and multiple group on the metastasis(P<0.05). While, there are significant difference between different diameter (P>0.05), the larger the tumor, the higher the possibility of metastasis.3. Tumor pathology:68cases of124the expression of CgA are positive and98cases of124the expression of Syn are positive. There are no correlation between the expression of CgA or Syn and metastasis of GEP-NETs(P>0.05).4.(1) Morphological, peritumoral lymphatic is round or expansion and intratumoral lymphatic atresia or flat;(3) There are no significant difference between Metastatic group and Without metastatic group on LVD. Lymph node involvement or not(t<0.05) and peritumoral LVD (t <0.05) are correlation with the metastasis of GEP-NETs while intratumoral LVD isn t(t>0.05).5.ROC curve analysis supports the tumor size (0.702) and the peritumoral LVD (0.708) have prognostic value on the metastasis of GEP-NETs. At the same time, the prognostic value is total LVD (0.635), stool changes (0.667),melena (0.600),age (0.616)Conclusion:l.The good age of GEP-NETs is40-60years, abdominal pain, stool changes, melena are the most common non-specificity symptoms of this tumor. Stool changes、Melena and Age are the risk factors of GEP-NETs.2The tumor size and the peritumoral Lymphatic vessel density may be useful prognostic tools for the metastasis of GEP-NETs, the larger the value is, the higher the metastasis of possibility. In addition, Stool changes、Melena、Age and Total LVD as the risk factors of GEP-NETs metastatic have lower prognostic value than the tumor size and the peritumoral Lymphatic vessel density.3.The changes of LVD during the metastasis process of GEP-NETs may be lymphangiogenesis. The changes of peritumoral lymphatic may be one of mechanism the metastasis of GEP-NETs.