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目的分析直肠神经内分泌肿瘤的临床病理特征和治疗模式。方法回顾性分析中国医学科学院肿瘤医院2004年3月至2009年9月收治的57例直肠神经内分泌肿瘤(RNET)患者的临床病理资料,分析其临床病理特征和治疗模式。结果患者主要首发症状为便血(22.8%)和腹泻(17.5%),肿瘤距肛缘中位距离5.0cm(3～15cm),肿瘤直径中位值0.8cm(0.2～8.0cm),CgA、Syn和NSE阳性率分别为57.6%、100%和95.2%。主要病理类型为典型类癌,占85.9%。TNM分期I期78.8%,Ⅱ期为3.9%,Ⅲ期为9.6%,Ⅳ期为7.7%。主要治疗方式为手术切除(占94.7%),术式包括局部切除和开腹切除。3例接受肝脏介入治疗,3例接受姑息放疗,5例接受姑息化疗。结论直肠神经内分泌肿瘤直径通常<1cm,好发于直肠中下段,TNM分期I期多见,淋巴结及远处转移少见。Syn和NSE为敏感性较高的检测指标,主要病理类型为典型类癌,局部切除可获得满意疗效。介入治疗、姑息放疗和化疗对缓解症状有效,但无确切证据提示可延长总生存时间。
Objective To analyze the clinicopathological characteristics and treatment modalities of rectal neuroendocrine tumors. Methods The clinical and pathological data of 57 patients with rectal neuroendocrine tumors (RNET) admitted from March 2004 to September 2009 in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. The clinicopathological features and treatment modalities were analyzed. Results The main symptoms of the patients were hematochezia (22.8%) and diarrhea (17.5%). The tumor was 5.0 cm (3-15 cm) from the anal verge and 0.8 cm (0.2-8.0 cm) And NSE positive rates were 57.6%, 100% and 95.2% respectively. The main pathological type of typical carcinoid, accounting for 85.9%. TNM stage I 78.8%, Ⅱ period of 3.9%, Ⅲ period of 9.6%, Ⅳ period of 7.7%. The main treatment for surgical resection (94.7%), surgical procedures including partial resection and open excision. 3 received liver intervention, 3 received palliative radiotherapy, and 5 received palliative chemotherapy. Conclusions The diameter of rectal neuroendocrine tumors is usually <1 cm, which occurs in the middle and lower rectum. TNM stage I is more common, lymph node and distant metastasis rare. Syn and NSE are sensitive indicators of detection, the main pathological type of typical carcinoid, local excision can be obtained satisfactory results. Interventional therapy, palliative radiotherapy and chemotherapy are effective in alleviating symptoms, but there is no conclusive evidence that prolongs overall survival.