Analysis Of Clinical Features And Prognostic Factors Of Primary Hepatic Neuroendocrine Tumors

Neuroendocrine tumors are a heterogeneous tumor derived from neuroendocrine cells and peptidergic neurons.Such tumors are relatively rare,accounting for less than 1%of all malignancies,and are more common in the gastrointestinal tract(57%)and respiratory tract(23%).Epidemiological data in recent years show that the incidence and prevalence of neuroendocrine tumors have increased significantly,with an estimated incidence of 5.2/100,000[1,2,3].According to the 2010 WHO Tumor Classification System of the Digestive System,the classification is based on the Ki-67 positive index and mitotic count,including three levels of G1,G2,and G3.The specific criteria are as follows:Ki67?2%,and the number of mitotic images is 1/10 high-power field of view(HPF)is G1;3%<Ki-67<20%,2<number of mitotic images<20/10 HPF is G2;Ki-67>20%,number of mitotic images>20/10 HPF is G3.G1 and G2 are well differentiated,and G3 is poorly differentiated.Among them,G1/G2 is called neuroendocrine tumor,and G3 is also called neuroendocrine cancer[4].Recently,a new G3 subgroup was defined,which is divided into highly differentiated or well-differentiated neuroendocrine tumors(NET G3)and poorly differentiated or poorly-differentiated neuroendocrine cancers(NEC G3),and it has been proven that the prognosis of them is different[5].Primary hepatic neuroendocrine tumors(PHNET)are primary in the liver,accounting for 0.3-4.0%of the entire NETs,and are rarely clinically described,they were first described by Edmondson in 1958[6].With the development of medical technology today,The diagnosis rate is gradually increasing,but there are few existing studies on PHNET,its clinical characteristics are still unclear,and the diagnosis and treatment methods and prognostic factors are still unclear.Therefore,collecting more samples for research and analysis to explore the clinical characteristics and diagnosis and treatment experience of primary hepatic neuroendocrine tumors(PHNET),and to analyze the factors affecting their prognosis,have profound significance for clinical research and work.ObjectiveThe purpose of this study was to explore the clinical characteristics,diagnosis and treatment experience of primary hepatic neuroendocrine tumors(PHNET),and to analyze the factors affecting their prognosis.MethodsRetrospective analysis of the clinical,pathological,and follow-up data of 21 patients diagnosed with PHNET admitted to the First Affliated Hospital of Zhengzhou University from 2012.1.1 to 2019.1.1.Analyze and summarize the general clinical characteristics,diagnosis,treatment experience and methods of the disease,the relationship between clinicopathological indicators and prognosis was analyzed by single factor analysis using log-rank test,and Cox proportional hazard regression model was used for multivariate analysis.Results1?Clinical data:21 cases PHNET patients,11 males and 10 females,male to female ratio of 1.1:1,with an average age of 60 years(36-75);upper abdominal pain,10(48%)cases,abdominal pain accompanied by nausea,vomiting 3(14%)cases,bloating 5(24%)patients,asymptomatic 3(14%)patients,21 PHNET patients showed no significant carcinoid syndrome,right upper quadrant tenderness 6(29%)patients;of HBV surface antigen positive 2(10%)cases;tumor markers show:CA-199 increased 6(29%)cases,CA-125 increased 7(33%)cases;8 patients with abnormal liver function(38%)cases;abdominal reinforcement CT scan were found in liver solid mass,single 4 wherein the liver(19%)cases,multiple liver 17(81%)with an average diameter of 58mm(22mm-147mm),14 cases of lymph node metastases(67%),3 cases of distant metastasis(14%);radical 5 hepatectomy(23%)cases,TACE+2 chemotherapy(10%)patients,chemotherapy alone 12(57%)of Example 2 treatment of support(10%)patients.2?Pathological immunohistochemistry and follow-up prognosis:5(24%)cases of neuroendocrine tumors,16(76%)cases of neuroendocrine carcinoma,4(25%)cases of NET G3,and 12(75%)cases of NEC G3.Immunohistochemistry showed:CK(+)71%(15/21),CK8/18(+)23%(5/21),CK7(+)23%(5/21),CK19(+)29%(6/21),Syn(+)100%(21/21),CD56(+)95%(20/21),CgA(+)48%(10/21).All 21 patients were followed up for 5 to 20 months.The median survival time was 8 months.The half-year survival rate was 71%(15/21).The one-year survival rate was 38%(8/21).Among them,10 died from liver failure,6 died from cachexia,and 1 died from renal failure,Four patients were alive until follow-up(follow-up visits were 5 months,5 months,6 months,and 6 months).3?Univariate analysis showed that the presence or absence of lymph node metastasis,whether surgical resection or not,tumor classification,and CK positive or not were the factors that affect the prognosis of patients with PHNET(P<0.05).4?Multivariate Cox risk regression analysis of whether patients had lymph node metastasis,whether they could be surgically resected,tumor grade,whether CK was positive or not,showed that inoperative resection(P=0.038,HR=8.99,95%CI:1.128-71.798)was an independent risk factor for patient prognosis.Conclusions1?PHNET is rare in clinical practice,and there is no significant difference between men and women.There is no specificity in clinical manifestations,tumor markers,and imaging.2?The diagnosis of PHNET requires pathological and immunohistochemical examinations and strict exclusion of primary liver lesions.3?Surgical resection is the preferred treatment method.The presence or absence of lymph node metastasis,surgical resection,tumor grade,and CK positive are closely related to the prognosis of patients with PHNET.Inability to perform surgical resection is an independent risk factor for the prognosis of patients with PHNET.