| Background and Objective:Gastric neuroendocrine neoplasmas are rare tumors that originate in gastrointestinal chromoblast-like cells.In 2010,WHO classifies neuroendocrine neoplasmas into neuroendocrine tumors,neuroendocrine carcinoma,and mixed adenoneuroendocrine carcinoma.Among them,neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma are high-grade G3 type,which are poorly differentiated,and have a poor prognosis.At present,the factors affecting the survival of patients with gastric NEC and MANEC are still unclear.Whether adjuvant therapy is needed after surgery,how to choose the treatment is still inconclusive.A study showed that a higher level of Complexin-2 predicts a shorter diseases free survival in large cell lung neuroendocrine carcinoma and small cell lung cancer.However,its prognostic value in gastric neuroendocrine tumors has not been reported.This study is to investigate the effects of clinicopathological features and adjuvant therapy on the prognosis of patients with G3 gastric neuroendocrine tumors;to analyze the expression of complexin-2 protein in G3 gastric neuroendocrine tumors and its prognostic significance.Methods:We retrospectively analyzed 124 cases of gastric neuroendocrine tumors treated with radical surgery.The neoplasms were classified into different types,grades and stages according to the standard of classification.Follow-up was conducted.Immunohistochemical staining methods was used to detect the expression of complexin-2 protein in G3 gastric neuroendocrine tumor tissues.Univariate analysis was performed using the Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazard regression model.Results:1.The 5-year survival rates of gastric neuroendocrine tumor,gastric neuroendocrine carcinoma and gastric mixed adenoneuroendocrine carcinoma patients were 100%,52.4% and 38.8%,respectively.Multivariate analysis showed that lymph node metastasis(P=0.030)and adjuvant therapy(P=0.017),especially cisplatin combined with etoposide regimen(HR=0.051,P=0.015)were independent prognostic factors for patients with gastric neuroendocrine carcinoma;and lymph node metastasis,distant metastasis,TNM stage and adjuvant therapy were not independent prognostic factors for patients with mixed adenoneuroendocrine carcinoma;2.CPLX2 protein level was significantly higher in gastric neuroendocrine tumors than that of gastric adenocarcinoma;compared to NET G1,the positive rate of CPLX2 protein in NET G2 and NEC was higher,and the difference was statistically significant.In G3 type gastric neuroendocrine tumors,CPLX2 level did not show significant correlation with age,gender,smoking history,T stage,N stage,M stage and TNM stage.The level of CPLX2 protein was not associated with the prognosis of patients with G3 gastric neuroendocrine tumors.Conclusion:1.The prognosis of postoperative patients with g-NEC was related to lymph node metastasis and adjuvant chemotherapy,but not related to T stage,M stage,Ki-67 index and other factors.Adjuvant chemotherapy can significantly improve the prognosis of patients.For patients with T stage ≥ 2,whether or not there is lymph node metastasis or distant metastasis,adjuvant chemotherapy is recommended after surgery.EP regimen is a reasonable choice.Whether the patients with gastric mixed adenoneuroendocrine carcinoma need adjuvant chemotherapy is needed to be identified by further study.2.The prognosis of patients with G3 gastric neuroendocrine tumors was not related to the expression of complexin-2 protein. |
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