| Objective:Neuroendocrine neoplasms(NENs)is a rare and heterogeneous tumor that can occur throughout the body,most commonly in the digestive system.This study aims to explore the clinical features and survival prognosis of NENs in different parts of the digestive system,so as to improve clinicians’diagnosis and treatment level of NENs in the digestive system.Methods:The information of digestive system NENs patients diagnosed in the Second People’s Hospital of Yunnan Province from January 2005 to December 2020 was collected,including name,gender,age,primary site of tumor,tumor diameter,pathological data,metastasis,treatment method,contact number,etc.SPSS 22.0 statistical software was used to analyze the general clinical data,pathological data and survival prognosis of the patients.During this period,follow-up was mainly conducted by telephone and outpatient review,and the follow-up period was December 31,2020.Results:1.General clinical data:A total of 112 patients met the inclusion criteria in this study,including 4 patients from 2005 to 2008,14 patients from 2009 to 2012,46 patients from 2013 to 2016,and 48 patients from 2017 to 2020.Among the 112 cases of digestive system NENs,there were 56 males and 56 females,with a male to female ratio of 1:1.The age of high incidence ranged from 30 to 60 years old,with an average of 48.27±13.27 years old.The most common primary site of tumor was rectum(58%),followed by duodenum(15.2%).There were 12 cases of appendix(10.7%),7 cases of stomach(6.3%),5 cases of pancreas(4.5%),2 cases of esophagus(1.8%),1 case of sigmoid colon(0.9%),1 case of jejunum(0.9%),1 case of liver(0.9%),and 1 case of gallbladder(0.9%)in the following order.None of the above 112 patients had a typical carcinoid syndrome,and the reasons for the treatment were as follows:including 31 patients(47.7%)with no obvious clinical symptoms of rectal NENs,16 patients(24.6%)with abdominal pain,6 patients(9.2%)with changes in stool habits,4 patients(6.2%)with abdominal distension,3 patients(4.6%)with constipation,3 patients(4.6%)with diarrhea,and 3 patients(4.6%)with rectal NENs.Blood in stool was found in 2 cases(3.1%).There were 9 cases of abdominal pain(52.9%),3 cases of abdominal distension(17.6%),3 cases of no obvious clinical symptoms(17.6%),and 2 cases of acid reflux(11.8%)in duodenal NENs.All patients in appendiceal NENs were admitted with acute appendicitis and clinical manifestations were acute abdominal pain(100%).There were 4 cases of abdominal pain(57.1%),2 cases of acid reflux(28.6%),and 1 case of anorexia(14.3%)in stomach NENs.There were 4 cases(80%)had abdominal pain and 1 case(20%)had abdominal mass in pancreatic NENs.There were 2 cases presented pharyngeal foreign body sensation of the esophageal NENs.The 1 cases sigmoid colon NENs presented stool habit change,the jejunum NENs 1 cases presented hematochezia,the liver NENs 1 cases presented abdominal pain,and the gallbladder NENs 1 cases presented no obvious clinical symptoms,which was found in physical examination.The primary site of the tumor was divided into groups,and the gender and age of NENs in the digestive system of different parts were compared.The P>0.05 showed no statistical difference.2.Pathological data:(1)Tumor size:Among the 112 patients in this study,the tumor size was replaced by the maximum diameter of the tumor,with an average diameter of 10.17mm,a minimum diameter of 2.0mm and a maximum diameter of 80mm.Among them,there were 92%of patients’tumor diameter was<20mm,and the rest 8%of patients’tumor diameter was≥20mm.(2)G grade:Among the 112 patients enrolled,G1 grade had the largest number of patients(93 cases in total,83%),followed by G2 grade with 14 cases(12.5%),and G3 grade with 5 cases(4.5%).(3)TNM stage:There were 92 patients(82.1%)in stage I,13 patients(11.6%)in stage Ⅱ,3 patients(2.7%)in stage Ⅲ,and 4 patients(3.6%)in stage Ⅳ.(4)Infiltration depth:Excluding the 2 patients who did not receive surgical treatment,the depth of tumor invasion in the remaining 110 patients was statistically analyzed,including 101 cases of mucosa and submucosa(90.2%),0 cases of muscular layer(0%),7 cases of serosal layer(6.3%),and 2 cases of outer serosal layer(1.8%).(5)Metastasis:Among the 112 patients included,6 cases(5.4%)had lymph node metastasis,9 cases(8%)had vascular infiltration,and 4 cases(3.6%)had distant metastasis.The tumor size,G grade,TNM stage,depth of invasion,vascular invasion,lymph node metastasis and distant metastasis of NENs in different parts of the digestive system were compared,and the results showed that there were statistical differences in tumor size,G grade,TNM stage,depth of invasion and distant metastasis of NENS in different parts of the digestive system(P<0.05).3.Treatment:In 112 cases of the patients,endoscopic treatment of 90 cases(64 cases of rectum,6 cases of stomach,2 cases of esophagus,17 cases of duodenum,1 cases of sigmoid colon),postoperative pathological results indicate there are 8 cases of vertical cut edge positive,for 8 cases of vertical cut edge positive patients,seven patients underwent endoscopic enlarged tissue resection,the other underwent subtotal gastrectomy.Surgical treatment was performed in 20 cases(4 cases of pancreas,12 cases of appendix,1 case of jejunum,1 case of liver,1 case of stomach,1 case of gallbladder),and chemotherapy was performed in 2 cases(1 case of rectum,1 case of pancreas).4.Follow-up:5 of the 112 patients were lost to follow-up,with a loss rate of 4.46%,and 107 patients were effectively followed-up.The follow-up cut-off date was December 31,2020,and the follow-up time was 2-168 months.By the end of the follow-up,a total of 12 patients died,including 9 tumor-related deaths.The 1-,3-and 5-year survival rates were 97.1%,96.1%and 93.7%,respectively,and the mean survival time was 127±11 months.5.Survival prognostic analysis:10 factors including gender,age,treatment,infiltration depth,TNM stage,G grade,vascular infiltration,lymph node metastasis,distant metastasis,and tumor size were selected for univariate analysis by Kaplan-Meier method.The results showed that the infiltration depth,TNM stage,G grade,lymph node metastasis,distant metastasis,tumor size and treatment method had statistically significant effects on the survival and prognosis of the patients(P<0.01).Multivariate Cox regression analysis did not find any independent risk factors.Conclusions:1.The incidence of NENs in the digestive system has increased compared with the previous period,with high incidence in the age group of 30-60 years old.The most common site of NENs is rectum,followed by duodenum,appendix,stomach and pancreas.2.Digestive system NENs usually has no typical clinical manifestations,and is usually found by physical examination or other gastrointestinal symptoms.After early diagnosis and surgical treatment,the prognosis is good.3.There were statistical significance in tumor size,G grade,TNM stage,invasion depth and distant metastasis of NENs in different parts of digestive system.Pancreatic NENs lesions have larger diameter,higher G grade and higher risk of metastasis.4.Univariate analysis showed that seven factors,including infiltration depth,TNM stage,G grade,lymph node metastasis,distant metastasis,tumor size and treatment methods,had statistically significant effects on the survival and prognosis of patients(P<0.01).The larger the tumor,the higher the G grade the higher the TNM stage,and the deeper the invasion,the patients with distant metastasis and lymph node metastasis had poor survival prognosis. |
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