| Objective To explore the clinicopathological features of gastric neuroendocrine tumors(G-NETs)and the risk factors affecting the prognosis of patients,as well as the value of neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)in the prognosis of G-NETs patients.Methods The clinicopathological data of 160 patients with G-NETs admitted to the Affiliated Hospital of XX from Jan.2013 to Dec.2019 were retrospectively analyzed,including general clinical data,laboratory indicators,endoscopic findings and pathological features,and follow-up work was performed to analyze the prognosis of the patients.Statistical software SPSS 26.0 was used for statistical analysis of all relevant data.Two independent samples t-test,Pearsona chi-square test or Fisher exact probability method were used to analyze the counting data between groups.First,Kaplan-Meier method and Log-rank test were used for univariate analysis,and then Cox regression multivariate analysis was performed for survival analysis.P<0.05 was considered statistically significant.Results(1)The male to female ratio of 160 patients with G-NETs was 2.27:1.The age of onset ranged from 30 to 86 years,with an average age of 60.06±10.56 years.The mean age of onset in male and female patients was 61.71±0.96 years and 56.31±1.52 years,respectively,and there was a statistical difference between them(t=3.063,P=0.003).The clinical symptoms of G-NETs patients were atypical,with abdominal pain(49.4%)and no clinical symptoms(10.6%).(2)The 160 patients with G-NETs presented with ulceration(82 cases,51.2%)and protuberance(78 cases,48.1%).Gastric fundus/body was the most common lesion site(87 cases(54.4%)).The largest tumor diameter ranged from 0.2cm to 16 cm,with an average of 3.84±3.56 cm.In addition,the lesion site and maximum diameter of the tumor showed statistical differences in tumor morphology.The protrude type were mostly located in the fundus/body of the stomach,and the maximum diameter of the tumors was smaller than that of the ulcerated type,of which 79.5%(62/78)were less than 2.0cm.(3)Among the 160 patients with G-NETs,there were 69 cases of neuroendocrine tumors(43.1%),61 cases of neuroendocrine carcinoma(38.1%),and 30 cases of mixed adeno-neuroendocrine carcinoma(18.8%);There were 48 cases of G1grade(30%),23 cases of G2 grade(14.4%)and 89 cases of G3 grade(55.6%).The clinicopathological characteristics of patients with G-NETS among different pathological grades were compared,and the results showed statistical differences in pathological grades in gender,age,smoking history,alcohol consumption history,tumor shape,size,site of onset,nerve or vascular invasion,lymph node and distant metastasis,and TNM stage(all P < 0.05).G3 patients are more common in men ≥60 years of age,with a history of smoking and alcohol consumption,ulcerative lesions with a maximum tumor diameter≥3.84 cm,NEC or MANEC pathology,TNM stage Ⅲ/Ⅳ,with nerve or vascular involvement,and with lymph node and distant metastasis.(4)The ROC curves of NLR and PLR were plotted by SPSS software,and the optimal critical values were 2.0 and139.4,respectively.The corresponding AUC were 0812 and 0.784,respectively.with statistical difference(both P < 0.001).There were 78 cases(48.8%)in the NLR≤2.0 group,82 cases(51.3%)in the NLR > 2.0 group,67 cases(41.9%)in the PLR≤139.4 group,and93 cases(58.1%)in the PLR > 139.4 group.Chi-square test shows the NLR group > 2.0,type,ulcers,cardia/gastric antrum,tumors,maximum diameter of 3.84 cm or more,TNMⅢ/Ⅳ period,grade G3 and pathological classification as NEC more proportion(all P <0.05),while in the PLR > 139.4 a group of men,age 60 or more,tumor shape of ulcer,tumor for maximum diameter of 3.84 cm or more,TNM Ⅲ/Ⅳ period,grade G3 and pathological classification as more proportion of NEC group(all P < 0.05).(5)The 160 patients with G-NETs were followed up for 3-91 months,with a mean survival time of(59.6±3.4)months.The 3-year and 5-year survival rates were 61.3% and 60.0%,respectively.Single factor survival analysis showed that gender,age,NLR,PLR,tumor shape,maximum diameter,site,Ki-67,pathological classification,pathologic stage,TNM staging,lymph node metastasis,distant metastasis,and treatment are related to the prognosis of patients(P < 0.05),Cox regression analysis showed that age,PLR,lymph node and distant metastasis were independent risk factors for survival and prognosis of G-NETS patients(P < 0.05),That is,patients with age ≥60 years,PLR > 139.4,and lymph node or distant metastasis had relatively poor prognosis.Conclusion(1)Patients with G-NETs tend to occur in men of 60 years of age,and their clinical symptoms are atypical.The tumor morphology can be ulcer ated or raised,and the lesion site is common in the fundus/body of the stomach.(2)Pathological grade may be related to the patient’s age,gender,smoking history,drinking history,tumor shape,size,site of disease,nerve or vascular invasion,TN M stage,lymph node and distant metastasis.(3)The 5-year survival rate of patien ts with G-NETs was 60.0%.Age ≥60 years,PLR > 139.4,with lymph node and di stant metastasis were independent risk factors for survival prognosis in patients wit h G-NETs.(4)Preoperative serological indicators such as neutrophil-lymphocyte r atio(NLR)and platelet/lymphocyte ratio(PLR)can be used to evaluate the progn osis of patients with G-NETs,and PLR is an independent risk factor for survival and prognosis in patients with G-NETs. |
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