245例消化系统神经内分泌肿瘤的内镜表现及病理特征分析
Endoscopic Manifestations and Pathological Features of 245 Cases of Neuroendocrine Tumors in the Digestive System

目的：探讨消化系统神经内分泌肿瘤(Neuroendocrine tumors, NETs)的流行病学、内镜表现及临床病理特征，以提高对该类疾病的诊治水平。方法：回顾性分析青岛大学附属医院消化内科自2013年2月至2020年9月诊断为NETs患者的临床资料，探讨其流行病学、内镜表现及临床病理特征。结果：共检出消化系统NETs患者245例，男性130例(53.1%)，女性115例(46.9%)，平均年龄(53.3 ± 12.3)岁。消化系统NETs好发部位以结直肠(127例，51.8%)和胃(81例，33.1%)最常见。肿瘤直径 ≤ 10.0 mm的患者有209例(85.3%)；10.0~20.0 mm25例(10.2%)；>20.0 mm 11例(4.5%)。病变多起源于黏膜肌层(55.4%)及黏膜下层(43.8%)。根据WHO分类标准，245例患者病理分期为NETG1的有204例(83.3%)；NETG2的有40例(16.3%)；NEC的有1例(0.4%)。免疫组化染色结果显示，Syn阳性率为95.1%，CgA阳性率为55.1%。上消化道与下消化道NETs在性别(P = 0.001)、肿瘤大小(P < 0.001)及病理分型(P < 0.001)存在统计学差异。结论：消化系统NETs的好发部位以结直肠和胃最常见。肿瘤直径绝大多数不超过10.0 mm，病变多起源于黏膜肌层及黏膜下层。ESD是既安全又有效的微创治疗方法。超声内镜对消化系统NETs具有较大的诊断价值。
Objective: To investigate the epidemiology, endoscopic manifestations and clinicopathological features of neuroendocrine tumors of the digestive system in order to improve the diagnosis and treatment of these diseases. Method: The clinical data of NETs patients diagnosed in department of Gastroenterology, Affiliated Hospital of Qingdao University from February 2013 to September 2020 were retrospectively analyzed to investigate the epidemiology, endoscopic manifestations and clinicopathological features. Results: A total of 245 patients with digestive NETs were detected, including 130 males (53.1%) and 115 females (46.9%), with an average age of 53.3 ± 12.3 years. The most common sites of gastrointestinal NETs were the colorectal (127 cases, 51.8%) and the stomach (81 cases, 33.1%). There were 209 patients (85.3%) with tumor diameter ≤ 10.0 mm. 25 patients (10.2%) with tumor diameter between 10.0 - 20.0 mm; 11 patients (4.5%) with tumor diameter > 20.0 mm. The tumor mostly originated in the muscularis mucosa (55.4%) and submucosa (43.8%). According to WHO classification criteria, 204 (83.3%) of 245 patients were diagnosed as NETG1 in pathological stage; 40 (16.3%) patients were diagnosed as NETG2; and only 1 (0.4%) patient were in NEC. The immunohistochemical staining results showed that the positive rate of Syn and CgA were 95.1% and 55.1% respectively. There were statistically significant differences between upper and lower gastrointestinal NETs in gender (P = 0.001), tumor size (P < 0.001), and pathological type (P < 0.001). Conclusion: Colorectal and stomach are the most common sites of gastrointestinal NETs. Most of the tumors are no more than 10.0 mm in diameter, and most of the lesions originate from the mucosal musculus and submucosa. ESD is a safe and effective minimally invasive treatment. Endoscopic ultrasonography is of great diagnostic value for NETs