摘要目的 探讨不同病理分级的消化系统神经内分泌肿瘤(NEN)的临床病理特点及预后情况.方法 根据2010年WHO消化系统肿瘤分类标准对139例消化系统NEN进行病理分级,复习其临床病理资料,免疫组织化学EnVision法检测突触素、嗜铬粒素A(CgA)和Ki-67.对所有患者进行随访,生存分析应用Kaplan-Meier法,生存率比较采用Log-rank检验,采用Cox回归分析进行多变量分析.结果 139例NEN病例中,1级88例(63.3％),2级9例(6.5％),3级42例(30.2％).不同病理分级的病例在肿瘤大小、浸润深度、脉管癌栓、神经侵犯、淋巴结转移和远处转移等方面的差异均具有统计学意义(均P＜0.05).1级和2级病例多为弥漫性表达突触素和CgA,而3级病例常为局灶性表达突触素和CgA.生存分析显示3组病例生存率之间的差异具有统计学意义(P＜0.05).结论 不同分级的消化系统NEN在临床病理、预后等方面差异均具有统计学意义.在临床工作中,要严格按照新标准对消化系统NEN进行命名和分级,以指导临床做出最佳治疗的选择和预后判断.

abstractsObjective To study the clinicopathologic and prognostic features of neuroendocrine neoplasm of digestive system with different grades.Methods The clinicopathologic features of 139 cases of neuroendocrine neoplasm occurring in digestive system were retrospectively reviewed and graded according to the 2010 World Health Organization classification of tumours of the digestive system.lmmunohistochemical study for synaptophysin,chromogranin A and Ki-67 was carried out.The follow-up and survival data were analysed using Kaplan-Meier method.Prognostic factors were tested by Log-rank testing and imdepemdemt risk factors were amalysed usimg Cox regressiom model.Results Amomgst the 139 cases studied,there were 88 cases(63.3％) of grade 1 tumors,9 cases(6.5％) of grade 2 tumors amd 42 cases(30.2％) of grade 3 tumors.There was diffusely positive staimimg for symaptophysim amd chromogranin A in most of the grade 1 and grade 2 tumors.The staining in grade 3 tumors however was focal(P ＜0.05).The differences in tumor size,depth of invasion,presence of tumor emboli,perineural permeation,nodal involvement,distant metastasis and survival rate amongst the three groups was statistically significant(P ＜ 0.05).Conclusions There is significant difference in the clinicopathologic and prognostic features of neuroendocrine neoplasm of digestive system with different grades.It is considered as an independent prognostic factor and represents a useful tool for prognostic evaluation of such tumors,both in clinical practice and research.