| Objective:Gastric and rectuml neuroendocrine neoplasms in patients with different pathological grading prognosis have obvious difference,this study through the retrospective analysis 230 cases of patients with gastric and rectum NENs,analysis about general information of the gastric and rectum NENs(gender,age,endoscopic and pathological features,etc.),screening and forecasting the danger of factors associated with pathologic grading,help to early discovery,early diagnosis,early treatment of the disease.Methods:230 patients with neuroendocrine neoplasms(NENs)of stomach and rectum with complete medical records were included in the first hospital of jilin university from January 2011 to December 2019.Digestive endoscopy and pathology were performed in all cases,and all pathological tissues were diagnosed,classified and graded by pathology and immunohistochemical examination.Retrospective analysis the age,sex,clinical manifestations,tumor characteristics(location of occurrence,maximum diameter,depth of invasion)and pathological characteristics of 230 patients were retrospectively analyzed.The similarities and differences in clinical characteristics of NENs in the stomach and rectum were compared,and the risk factors and predictors related to pathological grade were analyzed.Results:1.230 patients were included,39 in the gastric group and 191 in the rectum group.The ratio of male to female was 1.17:1 and 1.51:1,respectively.The mean age was 56.7±9.6 years and 50.2±10.6 years,respectively,with statistically significant differences(P<0.05).The most patients with gastric NENs were aged 60-69 years,with 16 cases(41.0%).The most patients with rectal NENs were aged 50-59 years,with 68 cases(35.6%).2.The most common symptoms of gastric NENs were abdominal pain(9/39,23%),diarrhea(6/39,15.4%),and abdominal distension,wasting,and loss of appetite.The common symptoms of patients with rectal NENs were 73(38.2%)of patients with bowel habit or character change,50(26.1%)of patients with abdominal pain,and 4(4.8%)of patients with perianal discomfort.3.Endoscopic findings: in the gastric group,there were 4 cases(10.3%)from the cardia,2 cases(5.1%)from the fundus,20 cases(51.3%)from the gastric body,and 13 cases(33.3%)from the gastric antrum.The general types were ulcer type(17 cases,43.6%),uplift type(14 cases,35.9%)and polyp type(8 cases,20.5%).There were 48 cases(25.1%)of low rectum(<5cm from anal margin),135 cases(70.7%)of middle rectum(5-10 cm from anal margin)and 8 cases(4.2%)of high rectum(10cm from anal margin).The general type of polyp was prominent(179,93.7%),8 cases were polyp(4.2%),and 4 cases were annular rectal infiltrating(2.1%).Among 112 patients,107 were uniformly hypoechoic(95.5%)and 5 were moderately echogenic(4.5%).4.Pathological features: the maximum diameter of NENs was 0.4-6.8cm,14 cases(35.9%)were <1cm,6 cases(15.4%)were 1-2cm,and 19 cases(48.7%)were >2cm.The mucosa and submucosa were invaded(53.8%),4 cases(10.3%)were invaded into the muscularis propria,and 14 cases(35.9%)were invaded into the serosal layer.There were 22 cases of net1,16 cases of G1,6 cases of G2 and 17 cases of G3(13 cases of NEC13 and 4 cases of MANEC4).The positive rate of Syn and CgA was 89.7% and 74.4% respectively.Among the 191 patients in the rectal group,158(82.7%)were <1cm,23(12.0%)were 1-2cm in diameter,and 10(5.3%)were 2cm in diameter.The lesions were located in mucosa and submucosa in 178 cases(93.2%),muscularis in 6 cases(3.1%),and intramuscular and serosal in 7 cases(3.7%).There were 187 cases of net1,172 cases of G1 and 15 cases of G2.G3 grade 4 cases(NEC2 cases,MANEC2 cases);The positive rate of Syn and CgA was 98.4% and 44.5% respectively.5.Univariate analysis showed that the patient’s gender,age,location of disease,general type,tumor diameter and invasion depth were important factors affecting and predicting the pathological grade of gastric NENs.The gross type,tumor diameter and invasion depth of the patient are important factors to predict the pathological grade of rectal NENs.Multivariate Logistic regression analysis was performed on the indicators with statistically significant differences: gastric antrum and cardiac lesions,infiltration depth to muscle layer and serous membrane suggested higher pathological grade of gastric NENs(P<0.05).However,only the infiltrating serous layer of the lesion was found in the rectum,indicating that the pathological grade of the lesion was higher(P<0.05).Conclusion:1.Gastric and rectum NENs tend to occur in middle-aged people,and are more common in men.The onset age of rectum NENs is younger than that of stomach NENs.2.The lack of specific symptoms of gastric and rectum NENs makes early detection difficult.3.Gastric NENs is mainly found in gastric body and gastric antrum.Rectum NENs is more common in the low and middle rectum,the general type is mainly uplift.4.Gross type and depth of infiltration were significant predictors of gastric NENs classification.The depth of infiltration was significant in predicting the pathological grade of rectal NENs. |
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