Analysis of The Diagnosis and Treatment of Gastroenteropancreatic Neuroendocrine Neoplasm in 70 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GONGHai-yan ¹ , GEWei ² , JIANGSong-song ² ,  CHENGang ²

1. Department of Physical Examination Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China;
2. Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China;

Corresponding author：

CHENGang, Email: gulou_hospital@163.com

Keywords：

Gastroenteropancreatic neuroendocrine neoplasm; Diagnosis; Treatment; Carcinoid

DOI：

10.7507/1007-9424.20140274

Video：

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Objective To summary the pathogenic site, clinical manifestations, endoscopic and radiographic features, pathologic characteristics, diagnosis, treatment, and prognosis of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN). Methods Clinical data of 70 cases of GEP-NEN who were treated in Nanjing Drum Tower Hospital from Jan. 2003 to Dec. 2012 were collected and retrospectively analyzed. Results Of the 70 cases, 35 cases(50.0%) were in pancreas, 18 cases(25.7%) were in rectum, 10 cases(14.3%) were in stomach, and 7 cases(10.0%) were in appendix; 55 cases(78.6%) were nonfunctional tumors, while 15 cases(21.4%) were functional; 50 cases(71.4%) were neuroendocrine tumor, 15 cases(21.4%) were neuroendocrine carcinoma, and 5 cases(7.2%) were mixed adenoendocrine carcinoma; 43 cases(61.4%) were in grade 1, 7 cases(10.0%) were in grade 2, and 20 cases(28.6%) were in grade 3 respectively. The detection rate of endoscopy, type-B ultrasonic, CT, and MRI were 90.0%(27/30), 67.9% (19/28), 86.0%(43/50), and 70.0%(7/10) respectively. A total of 67 patients(95.7%) were underwent surgery, including endoscopic resection, and 3 cases (4.3%) didn't receive surgery. Forty cases were followed-up for 6 months to 9 years(the median survival time was 3 years), and the 1-, 3-, and 5-year survival rates were 82.5%(33/40), 47.5%(19/40), and 35.0%(14/40) respectively. Conclusion GEP-NEN occurs mainly in pancreas, and the clinical manifestations are variable. Endoscopy and radiographic examination methods play an important role in diagnosis of GEP-NEN, but final diagnosis is mainly based on pathological detection. Surgery is the main treatment method for it.

Citation： GONGHai-yan, GEWei, JIANGSong-song, CHENGang. Analysis of The Diagnosis and Treatment of Gastroenteropancreatic Neuroendocrine Neoplasm in 70 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1145-1148. doi: 10.7507/1007-9424.20140274 Copy

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2.	中国胃肠胰神经内分泌肿瘤病理专家组. 中国胃肠胰神经内分泌肿瘤病理学诊断共识[J]. 中华病理学杂志, 2011, 40(4):257-262.
3.	Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13715 carcinoid tumors[J]. Cancer, 2003, 97(4):934-959.
4.	Yao JC, Hassan M, Phan A, et al. One hundred years after "carcinoid":epidemiology of and prognostic factors for neuroendocrine tumors in 35825 cases in the United States[J]. J Clin Oncol, 2008, 26(18):3063-3072.
5.	Klimstra DS, Modlin IR, Adsay NV, et al. Pathology reporting of neuroendocrine tumors:application of the Delphic consensus process to the development of a minimum pathology data set[J]. Am J Surg Pathol, 2010, 34(3):300-313.
6.	Toth-Fejel SE, Pommier RF. Relationships among delay of diagnosis, extent of disease, and survival in patients with abdominal carcinoid tumors[J]. Am J Surg, 2004, 187(5):575-579.
7.	Eriksson B, Oberg K, Stridsberg M. Tumor markers in neuroendocrine tumors[J]. Digestion, 2000, 62 Suppl 1:33-38.
8.	杨晓鸥, 钱家鸣, 李景南. 血浆嗜铬粒蛋白A对胃肠胰腺内分泌肿瘤的诊断价值[J]. 胃肠病学, 2008, 13(4):205-208.
9.	Kulke MH, Anthony LB, Bushnell DL, et al. NANETS treatment guidelines well-differentiated neuroendocrine tumors of the stomach and pancreas[J]. Pancreas, 2010, 39(6):735-752.
10.	王钰虹, 林原, 薛玲, 等. 87例胃肠胰神经内分泌肿瘤的诊治分析[J]. 中华消化杂志, 2011, 31(8):531-535.
11.	盖保东, 肖钟迪. 胃肠胰腺神经内分泌肿瘤诊治进展[J]. 中华内分泌外科杂志, 2009, 3(2):76-79.
12.	刘曦娇, 王威亚, 黄子星, 等. 胰腺神经内分泌癌的影像学表现[J]. 中国普外基础与临床杂志, 2012, 19(10):1126-1129.
13.	何云飞, 冯仕庭, 李子平. 胃肠胰神经内分泌肿瘤的影像诊断进展[J]. 国际医学放射学杂志, 2012, 35(1):53-58.
14.	Meyer T, Qian W, Caplin ME, et al. Capecitabine and streptozocin±cisplatin in advanced gastroenteropancreatic neuroendocrine tumours[J]. Eur J Cancer, 2014, 50(5):902-911.
15.	Kamp K, Gumz B, Feelders RA, et al. Safety and efficacy of everolimus in gastrointestinal and pancreatic neuroendocrine tumors after (177)Lu-octreotate[J]. Endocr Relat Cancer, 2013, 20(6):825-831.
16.	Meeker A, Heaphy C. Gastroenteropancreatic endocrine tumors[J]. Mol Cell Endocrinol, 2014, 386(1-2):101-120.
17.	Grande E, Díez JJ, Pachón V, et al. Advances in the therapy of gastroenteropancreatic-neuroendocrine tumours (GEP-NETs)[J]. Clin Transl Oncol, 2010, 12(7):481-492.
18.	Oberg K, Akerström G, Rindi G, et al. Neuroendocrine gastroenteropancreatic tumours:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2010, 21 Suppl 5:v223-v227.
19.	陈曦, 周光文. 胰腺神经内分泌肿瘤诊治热点探讨[J]. 中国普外基础与临床杂志, 2012, 19(10):1033-1038.
20.	杨春明. 常见胰腺神经内分泌肿瘤的诊断和治疗[J]. 中国普外基础与临床杂志, 2012, 19(10):1029-1032.
21.	Raymond E, Dahan L, Raoul JL, et al. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors[J]. N Engl J Med, 2011, 364(6):501-513.
22.	Yao JC, Shah MH, Ito T, et al. Everolimus for advanced pancreatic neuroendocrine tumors[J]. N Engl J Med, 2011, 364(6):514-523.
23.	Cho MY, Sohn JH, Jin SY, et al. Proposal for a standardized pathology report of gastroenteropancreatic neuroendocrine tumors:prognostic significance of pathological parameters[J]. Korean J Pathol, 2013, 47(3):227-237.
24.	2013年中国胃肠胰神经内分泌肿瘤病理诊断共识专家组. 中国胃肠胰神经内分泌肿瘤病理诊断共识(2013版)[J]. 中华病理学杂志, 2013, 42(10):691-694.
25.	Ter-Minassian M, Chan JA, Hooshmand SM, et al. Clinical presentation, recurrence, and survival in patients with neuroendocrine tumors:results from a prospective institutional database[J]. Endocr Relat Cancer, 2013, 20(2):187-196.

1. Bosman FT, Carneiro F, Hruban RH, et al. WHO classification of tumors of the digestive system[M]. 4th ed. Lyon:IARC Press, 2010:2-5.
2. 中国胃肠胰神经内分泌肿瘤病理专家组. 中国胃肠胰神经内分泌肿瘤病理学诊断共识[J]. 中华病理学杂志, 2011, 40(4):257-262.
3. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13715 carcinoid tumors[J]. Cancer, 2003, 97(4):934-959.
4. Yao JC, Hassan M, Phan A, et al. One hundred years after "carcinoid":epidemiology of and prognostic factors for neuroendocrine tumors in 35825 cases in the United States[J]. J Clin Oncol, 2008, 26(18):3063-3072.
5. Klimstra DS, Modlin IR, Adsay NV, et al. Pathology reporting of neuroendocrine tumors:application of the Delphic consensus process to the development of a minimum pathology data set[J]. Am J Surg Pathol, 2010, 34(3):300-313.
6. Toth-Fejel SE, Pommier RF. Relationships among delay of diagnosis, extent of disease, and survival in patients with abdominal carcinoid tumors[J]. Am J Surg, 2004, 187(5):575-579.
7. Eriksson B, Oberg K, Stridsberg M. Tumor markers in neuroendocrine tumors[J]. Digestion, 2000, 62 Suppl 1:33-38.
8. 杨晓鸥, 钱家鸣, 李景南. 血浆嗜铬粒蛋白A对胃肠胰腺内分泌肿瘤的诊断价值[J]. 胃肠病学, 2008, 13(4):205-208.
9. Kulke MH, Anthony LB, Bushnell DL, et al. NANETS treatment guidelines well-differentiated neuroendocrine tumors of the stomach and pancreas[J]. Pancreas, 2010, 39(6):735-752.
10. 王钰虹, 林原, 薛玲, 等. 87例胃肠胰神经内分泌肿瘤的诊治分析[J]. 中华消化杂志, 2011, 31(8):531-535.
11. 盖保东, 肖钟迪. 胃肠胰腺神经内分泌肿瘤诊治进展[J]. 中华内分泌外科杂志, 2009, 3(2):76-79.
12. 刘曦娇, 王威亚, 黄子星, 等. 胰腺神经内分泌癌的影像学表现[J]. 中国普外基础与临床杂志, 2012, 19(10):1126-1129.
13. 何云飞, 冯仕庭, 李子平. 胃肠胰神经内分泌肿瘤的影像诊断进展[J]. 国际医学放射学杂志, 2012, 35(1):53-58.
14. Meyer T, Qian W, Caplin ME, et al. Capecitabine and streptozocin±cisplatin in advanced gastroenteropancreatic neuroendocrine tumours[J]. Eur J Cancer, 2014, 50(5):902-911.
15. Kamp K, Gumz B, Feelders RA, et al. Safety and efficacy of everolimus in gastrointestinal and pancreatic neuroendocrine tumors after (177)Lu-octreotate[J]. Endocr Relat Cancer, 2013, 20(6):825-831.
16. Meeker A, Heaphy C. Gastroenteropancreatic endocrine tumors[J]. Mol Cell Endocrinol, 2014, 386(1-2):101-120.
17. Grande E, Díez JJ, Pachón V, et al. Advances in the therapy of gastroenteropancreatic-neuroendocrine tumours (GEP-NETs)[J]. Clin Transl Oncol, 2010, 12(7):481-492.
18. Oberg K, Akerström G, Rindi G, et al. Neuroendocrine gastroenteropancreatic tumours:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2010, 21 Suppl 5:v223-v227.
19. 陈曦, 周光文. 胰腺神经内分泌肿瘤诊治热点探讨[J]. 中国普外基础与临床杂志, 2012, 19(10):1033-1038.
20. 杨春明. 常见胰腺神经内分泌肿瘤的诊断和治疗[J]. 中国普外基础与临床杂志, 2012, 19(10):1029-1032.
21. Raymond E, Dahan L, Raoul JL, et al. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors[J]. N Engl J Med, 2011, 364(6):501-513.
22. Yao JC, Shah MH, Ito T, et al. Everolimus for advanced pancreatic neuroendocrine tumors[J]. N Engl J Med, 2011, 364(6):514-523.
23. Cho MY, Sohn JH, Jin SY, et al. Proposal for a standardized pathology report of gastroenteropancreatic neuroendocrine tumors:prognostic significance of pathological parameters[J]. Korean J Pathol, 2013, 47(3):227-237.
24. 2013年中国胃肠胰神经内分泌肿瘤病理诊断共识专家组. 中国胃肠胰神经内分泌肿瘤病理诊断共识(2013版)[J]. 中华病理学杂志, 2013, 42(10):691-694.
25. Ter-Minassian M, Chan JA, Hooshmand SM, et al. Clinical presentation, recurrence, and survival in patients with neuroendocrine tumors:results from a prospective institutional database[J]. Endocr Relat Cancer, 2013, 20(2):187-196.

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Analysis of The Diagnosis and Treatment of Gastroenteropancreatic Neuroendocrine Neoplasm in 70 Cases

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