Clinicopathological Characteristics And Prognostic Analysis Of 47 Duodenal Neuroendocrine Neoplasms

BackgroundNeuroendocrine neoplasms(NENs)are a heterogeneous group of neoplasms,which originate from the neuroendocrine cells,including the benign indolent clinical course neoplasms and the malignancy with distant metastasis.A large proportion synthesis of hormone,peptides,amines that may be biologically active.The specific pathogenesis and etiology are still unknown,gene mutation,environmental factors,and unhealthy living habits may contribute to the diseases.The NENs occur in the duodenum named duodenal neuroendocrine neoplasms(d-NENs)and that are relatively rare neoplasms.Although that occur worldwide,most repots of d-NENs are found in Europe,North America,Japan,South Korean,and China.The majority of dNENs lack of specific clinical characteristics,and we need combine the Upper gastrointestinal endoscopic evaluation,histopathology results,and conventional imaging tests findings to establish the diagnosis.D-NENs have been increasing in both incidence and prevalence,this is likely due to increased use of upper gastrointestinal endoscopy and physician awareness.Studies have often combined d-NENs with other small bowel gastroenteropancreatic neuroendocrine tumors,while due to the different anatomical position,more research have found different clinical features,biological behaviors,and prognosis in them,so it is necessary to study the d-NENs alone.Based on individual case reports and a few single institutional studies,our understandings are at a low level.The optimal management of d-NENs and the relevant factor of prognosis are unclear.Because of the limitation of researches and awareness in china,it is essential to add more study in the clinicopathologic features and prognostic factors of d-NENs to formulated diagnosis and treatment.ObjectIn the research,we investigate the clinicopathologic features,therapeutic strategy,and the conditions of prognosis of 47 duodenal neuroendocrine neoplasms in our hospital through retrospective analysis.Furtherly provide a reference for their diagnosis,treatment,and prognosis evaluation.MethodsCollecting the integrity clinical data of 47 Patients who were histologically diagnosed as duodenal neuroendocrine neoplasms and the between June 2013 and June 2018 at the First Affiliated Hospital of Zhengzhou University.Their demography,clinical pathology,treatment,follow-up data,and prognosis were retrospectively evaluated.Statistical analysis was performed using SPSS21.0 statistical software.Results1.The study gathered of 47 duodenal neuroendocrine neoplasms patients,the number of male and female are 27(57.4%)and 20(42.6%),the male-to-female ratio is 1.35:1,the average age is(58.3±8.291)(40?69).patients lack of specific clinical characteristics,Histopathology with immunohistochemical test is basic necessary to establish the diagnosis.2.D-NENs arise more frequently in the first and second part of the duodenum,the average diameter is(15.5±11.08)millimeter(5?40),limited to the mucosa and submucosa(28/47,59.6%).19(40.4%)patients have metastasis at the time of definite diagnosis.Among 47 patients,the number of pathological grade of 1,2,3 are 25(53.2%),15(31.9%)and 7(14.9%),respectively,and the number of TNM staging in the I,II,III,IV stage are 20(42.6%),8(17.0%),12(25.5%),and 7(14.9%).There is no significant difference in age,gender,primary site of tumor,Chromogranin A(CgA),and synaptophysin(Syn)in different pathological grade of d-NENs(P> 0.05).However,There is significant difference between tumor diameter,depth of invasion,TNM staging,regional lymph node metastasis and distant metastasis(P<0.05).Compared to duodenal neuroendocrine cancers,duodenal neuroendocrine tumors patients have lower TNM staging(P <0.001),shorter tumor diameter(P =0.033),superficial depth of invasion(P <0.001),and less metastasis(P <0.001).3.In the fellow up period,2 patients died of other diseases,the rate of follow up is 45/47(95.7%).The 6-month,1-,and 3-year overall survival rates are 97.9%,95.7% and 88.3%,respectively.In the G3 of pathological grade patients,the 1-,and 3-year overall survival rates are 85.7% and 38.1%.The results of Analysis of Log-rank show that gender,age,expression of Chromogranin A(CgA),and synaptophysin(Syn)did not influence prognosis of patients with d-NENs(P>0.05),nevertheless,the tumor diameter,primary site of tumor,depth of invasion,metastasis,pathological grade,and TNM staging are the factors that influenced prognosis of patients with d-NENs(P<0.05).COX regression analysis suggests that : primary site of tumor and pathological grade are independent factors affecting prognosis.Conclusions1.Duodenal neuroendocrine neoplasms are rare and heterogeneous tumors,occurring both in male and female,and often occurs in the middle and old men,arise more frequently in the first and second part of the duodenum.The clinical manifestations lack of specificity and are similar to the common digestive tract diseases.Histopathology with immunohistochemical test is basic necessary to establish the diagnosis,it also need to combine with detection of serology relevant markers and the conventional imaging tests findings.2.Duodenal neuroendocrine neoplasms with a high rate of overall survival and a good prognosis,nevertheless,the G3 of pathological grade duodenal neuroendocrine cancers with a poor prognosis.Surgical resection and endoscopic resection are the main methods of treatment.The tumor diameter,primary site of tumor,depth of invasion,metastasis,pathological grade,and TNM staging are the factors that influenced prognosis of patients with d-NENs.The primary site of tumor and pathological grade are independent risk factors of overall survival.