| Background:Gastric neuroendocrine neoplasms (G-NENs) contain a group of heterogeneous tumors. Type I G-NENs is the most common clinical subtype and has an increasing morbidity recently. Our aim is to describe the clinicopathological profile, morphological charactristic, management and outcomes of type I G-NENs. And we give the accsess of a new therapy: traditional Chinese medicine (TCM), to observe its influence on recurrence and progress-free-survival (PFS) of type I G-NENs patients. Methods:Classifying the G-NENs patients seen at China-Japan Friendship Hospital from June 2011 to April 2016, we identified 63 patients with type I G-NENs. We generated a dataset emcompassing clinical, pathological and endoscopic factor and patients could receive tests including serum gastrin and CgA,24h intragastric pH monitoring, multifocal gastric mucosa biopsy examitation, APCA, VitB12, etc. There are four available approuchs:TCM, endoscopy, somatostatin analogue therapy (SSA) and surgery, for patients with type I G-NENs after receiving endoscopic treatment. Results: The 63 cases of type I G-NENs accounted to 45.32% among all G-NENss during the same period and 53.97% of them were femal.96.83% patients had hypergastrinemia and 39 patients tested 24h intragastric pH mornoring, all diagnosed as achlorhydria. Median tumor size was 0.5cm,87.30% displayed multiple lesions in fundus and body of stomach, and 71.43% were polypoid. Tumors were either NET G1 (80.95%) or NET G2 (19.05%). Clinical symptoms are mainly upper abdominal fulless and extending (65.08%), and beltching (50.79%).95.24% patients were diagnosed as chronic atrophic gastritis, while 63.49% PCA positive and 65.07% Vitamin B12 deficient.25.40% patients got malignant anemia and 34.92% got Hashimoto’s thyroiditis. All patients received endoscopic resection at first, then 36 (57.14%) taken TCM therapy,19 (30.16%) follow-up with upper endoscopy,5 (7.94%) SSA and 3 (4.76%) surgery. 36 patients had more than 8m follow-up period, and median was 21.5m. Among them there’re 23 patients with TCM and 22 (95.65%) free of recurrence or progress. As results, the PFS was up to 18m, with one progressed after a 16-month TCM. Decrease of serum CgA level occured in 6 patients (26.09%) with long-term TCM. At the end of the follow-up, all patients were alive, with only one case invades local lymphnode at diagnosis. Conclusion:Type I G-NENs is the most common subtype of G-NENs, usually in femal. It is associated with autoimmune atrophic gastritis, with a typical endoscopic performance:multiple and small polypoid lesions in gastric fundus and body. Type I G-NENs is well differentiated with good prognosis and often diagnosed atuoimmune thyroiditis at the same time. These characteristics are consistent with foreign reports. TCM therapy with smoothing liver and strengthening spleen could lead to a remarkable remission of symptoms, decline recurrence and entand PFS of type I G-NENs, and result in a drop of serum CgA level. |
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