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目的探讨消化道神经内分泌癌(neuroendocrine carcinomas,NECs)患者的临床特征及其预后因素分析。方法回顾性分析2004年3月至2014年3月收治的102例消化道NECs患者资料,其中男性64例,女性38例。分析患者临床特征,生存分析采用Kaplan-Meier生存曲线,预后因素分析的单因素分析采用Log-rank检验,多因素分析采用Cox比例风险回归模型。结果 102例消化道NECs中,位于胃、十二指肠59例(57.84%),结直肠18例(17.65%),空回肠11例(10.78%),食管14例(13.73%)。就诊症状:腹泻6例(5.88%),转移瘤症状13例(12.75%),原发肿瘤引起的症状80例(78.43%),无症状3例(2.94%)。免疫组化法检测:突触素(Syn)阳性表达102例(100.00%),嗜铬粒蛋白A(Cg A)阳性表达63例(61.76%)。102例患者中,生存时间最短1个月,最长125个月,中位生存时间为(31.00±6.08)个月,患者1年生存率52.94%,3年生存率38.24%,5年生存率27.45%。单因素分析结果显示,与消化道NECs患者预后有关的因素有年龄、肿瘤大小以及TNM分期(P均<0.05),而性别、原发部位、淋巴结转移以及辅助化疗与患者预后无关(P均>0.05)。Cox比例风险回归模型分析显示,TNM分期、肿瘤大小以及年龄是影响消化道NECs患者预后的独立危险因素。结论消化道NECs一般多发于男性,患者术后生存率偏低,年龄、TNM分期以及肿瘤大小是影响患者预后的独立因素。
Objective To investigate the clinical features and prognostic factors of patients with neuroendocrine carcinomas (NECs) in the digestive tract. Methods Data of 102 patients with digestive tract NECs admitted from March 2004 to March 2014 were retrospectively analyzed, including 64 males and 38 females. The clinical characteristics of the patients were analyzed. Kaplan-Meier survival curves were used for survival analysis. The Log-rank test was used for the single factor analysis of prognostic factors analysis. The Cox proportional hazards regression model was used for multivariate analysis. Results Of the 102 NECs in the digestive tract, 59 were in the stomach and duodenum (57.84%), 18 in the colorectal (17.65%), 11 in the empty ileum (10.78%), and 14 in the esophagus (13.73%). Symptoms: Diarrhea in 6 patients (5.88%), metastatic tumor in 13 patients (12.75%), primary tumors in 80 patients (78.43%), and asymptomatic in 3 patients (2.94%). Immunohistochemical assay: 102 cases (100.00%) of synaptophysin (Syn) positive expression, 63 cases (61.76%) of positive expression of chromogranin A (Cg A). Among 102 patients, the shortest survival time was 1 month and the longest was 125 months. The median survival time was (31.00±6.08) months. The 1-year survival rate was 52.94%, the 3-year survival rate was 38.24%, and the 5-year survival rate was 27.45%. Univariate analysis showed that the factors related to the prognosis of patients with digestive tract NECs were age, tumor size, and TNM stage (P<0.05). Gender, primary site, lymph node metastasis, and adjuvant chemotherapy did not correlate with patient prognosis (P>0.05). 0.05). Cox proportional hazards regression analysis showed that TNM staging, tumor size, and age were independent risk factors for the prognosis of patients with digestive tract NECs. Conclusion NECs in the digestive tract usually occur in males. The postoperative survival rate is low, and age, TNM stage, and tumor size are independent factors influencing the prognosis of patients.