| Jianguo Sun,Xiaodong Zhang,Songjing Lei,Jingzhong Xu,Zhaoyang Qin. Clinicopathological characterization of gastroenteropancreatic neuroendocrine neoplasms: retrospective study of 48 cases. Oncol Transl Med, 2018, 4: 163-170. |
| Clinicopathological characterization of gastroenteropancreatic neuroendocrine neoplasms: retrospective study of 48 cases |
| Received:July 30, 2018 Revised:September 12, 2018 |
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| KeyWord:gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs); Ki 67/MIB-1 index; mitotic rate ; diagnosis; prognosis |
| Author Name | Affiliation | Postcode | | Jianguo Sun | Department of Endocrinet, Rizhao Lanshan District People's Hospital, Rizhao 276826, China | 276826 | | Xiaodong Zhang | Department of Laboratory, The Centers for Disease Control and Prevention of Rizhao, Rizhao 276826, China | | | Songjing Lei | Department of Imaging, Weihaiwei People's Hospital, Weihai 264200, China | | | Jingzhong Xu | Department of Endocrinae, Rizhao Lanshan District People's Hospital, Rizhao 276826, China | | | Zhaoyang Qin | Department of General Surgery, Rizhao People's Hospital, Jining Medical University, Rizhao 276826, China | 276800 |
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| Abstract: |
| Objective Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) constitute a rare and
heterogeneous group of tumors with varied biology and still constitute a diagnostic and therapeutic challenge
for physicians of all specialties. In the present study, we aimed to review and study the clinicopathological
characteristics of GEP-NENs applying the World Health Organization (WHO) 2010 grading criterion.
Methods A total of 48 patients were enrolled in the study. The study included patients diagnosed with
GEP-NENs who were treated and followed up at our Hospital from January 2013 to December 2017. Data
regarding clinicopathological features of the patients were retrospectively evaluated. The expression of
neuroendocrine markers was measured using the immunohistochemical Ultra SensitiveTM S-P method of
staining in 48 cases of primary GEP-NENs; and serum levels of neuron-specific enolase, carbohydrate
an-tigen 19-9, and carcinoembryonic antigen in 36 GEP-NEN patients were measured using the
electrochemiluminescence method.
Results The median age at presentation was 59.3 (range 48–82) years, and 39 cases (81.3%) were
seen between the 5th and 6th decades. There was a male predilection (male: female=3:1). In 79.2% cases
(38/48), tumors were hormonally nonfunctional. The most common presentation was abdominal pain, and
the most frequent primary site of the tumor was the rectum, followed by the stomach (n = 15, 31.3%), colon
(n = 5, 10.4%), and so on. Of the 48 tumors, 16 (33.3%) were G1, 6 (12.5%) cases were G2, 16 (33.3%)
were neuroendocrine carcinoma (NEC), and 10 (20.8%) were mixed adenoneuroendocrine carcinoma
(MANEC). According to the AJCC/UICC classification, 45.8% (n = 22) were diagnosed at low stage (stage
I or II) while 54.2% (n = 26) were diagnosed at high stage (stage III or IV) (the majority of NEC, G3, and
MANEC). A male preponderance was noted for all tumors except for G2 neoplasms, which showed no
gender predilection. Thirty-nine patients underwent endoscopic biopsy. The lesions in 18.8% (n = 9) of the
patients were indentified only radiologically. After the surgical procedures, 36 had at least one follow-up visit
with a median follow-up duration of 5 months; the mean follow-up period was 28 ± 16 months. The oneyear
and three-year survival rates were 72.2% (26/36) and 61.1% (22/36), respectively. This study did not
find an effect of grade 3 (G3) of tumor on the short-term clinical outcome of these patients. In the survival
analysis, NEN G3, higher stage (stage III or IV) according to the AJCC/UICC classification (P < 0.05), and
metastases at diagnosis (P < 0.05) were associated with poorer prognosis.
Conclusion Most GEP-NENs are nonfunctional and nonspecific in presentation. The most frequent
primary site of the tumor was the rectum and the commonest ages at diagnosis were the 5th and 6th
decades. Endoscopic biopsy is the main diagnostic and histological grading method for GEP-NEN. In the
survival analysis, NEN G3, a higher stage according to the AJCC/UICC classification, and metastases at
diagnosis are associated with poorer prognosis.. |
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