作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Current Status and Controversies in the Diagnosis and Treatment of Gastric Neuroendocrine Neoplasms
-
摘要: 随着胃神经内分泌肿瘤(gastric neuroendocrine neoplasms，G-NENs)发病率的不断提高，临床医生对该病的认识也在不断加深，但有关G-NENs的诊断及治疗目前仍存在较多争议。本文通过文献回顾，就G-NENs的诊治现状作一综述并对现存争议进行讨论，旨在为临床规范化诊疗提供参考。Abstract: With the increasing morbidity of gastric neuroendocrine neoplasms (G-NENs), the understanding of clinicians about G-NENs is also deepening. However, there are still many controversies regarding the diagnosis and treatment of G-NENs. Therefore, this article reviews the current status of diagnosis and treatment of G-NENs through a literature review, and discusses the existing controversies, with the aim of providing reference for clinicians in standardized diagnosis and treatment.
-
Key words:
- gastric neuroendocrine neoplasms /
- diagnosis /
- treatment /
- controversy
作者贡献：崔婷、李金洲负责查阅文献并撰写论文；雷霞、李继昂、冯洁负责论文修订；黄晓俊提供写作思路。利益冲突：所有作者均声明不存在利益冲突 -
表 1 我国常用的G-NENs临床分型及其特征
分型 占比(%) 相关疾病 发生部位 血清胃泌素水平 胃内pH值 Ⅰ型 70~80 A型萎缩性胃炎 胃底/体 升高 明显升高 Ⅱ型 5~6 胃泌素瘤/MEN1 胃底/体 明显升高 明显下降 Ⅲ型 14~25 无 任意部位 正常 正常 Ⅳ型 6~8 无 任意部位 正常 正常 G-NENs：胃神经内分泌肿瘤；MEN1：多发性内分泌腺瘤病1型 
下载: 导出CSV
表 2 G-NENs与胃癌TNM分期中N(区域淋巴结)的差异
N G-NENs的TNM分期 胃癌的TNM分期 Nx 区域淋巴结不能评价 区域淋巴结不能评价 N0 无区域淋巴结转移 无区域淋巴结转移 N1 有区域淋巴结转移 1~2个区域淋巴结转移 N2 - 3~6个区域淋巴结转移 N3 - ≥7个区域淋巴结转移 N3a - 7~15个区域淋巴结转移 N3b - ≥16个区域淋巴结转移 G-NENs：同表 1
下载: 导出CSV
表 3 世界卫生组织2019年胃肠道和肝胆胰神经内分泌肿瘤病理分类和分级标准
分类/分级 分化程度 分级 核分裂像计数(个/2 mm2) Ki-67指数(%) NET G1 好 低 ＜2 ＜3 G2 好 中 2~20 3~20 G3 好 高 ＞20 ＞20 NEC 小细胞型 差 高 ＞20 ＞20 大细胞型 差 高 ＞20 ＞20 MiNEN 好/差 不定 不定 不定 NET：神经内分泌瘤；NEC：神经内分泌癌；MiNEN: 混合性神经内分泌-非神经内分泌肿瘤
下载: 导出CSV
-
[1] 刘雪梅, 庹必光. 胃肠神经内分泌肿瘤的内镜诊断与治疗[J]. 中华胃肠外科杂志, 2021, 24: 854-860. https://cdmd.cnki.com.cn/Article/CDMD-10366-1021716199.htm [2] Cives M, Strosberg JR. Gastroenteropancreatic Neuroendocrine Tumors[J]. CA Cancer J Clin, 2018, 68: 471-487. doi: 10.3322/caac.21493 [3] Exarchou K, Stephens NA, Moore AR, et al. New Developments in Gastric Neuroendocrine Neoplasms[J]. Curr Oncol Rep, 2022, 24: 77-88. doi: 10.1007/s11912-021-01175-y [4] Roberto GA, Rodrigues CMB, Peixoto RD, et al. Gastric neuroendocrine tumor: A practical literature review[J]. World J Gastrointest Oncol, 2020, 12: 850-856. doi: 10.4251/wjgo.v12.i8.850 [5] 中华医学会消化病学分会胃肠激素与神经内分泌肿瘤学组. 胃肠胰神经内分泌肿瘤诊治专家共识(2020·广州)[J]. 中华消化杂志, 2021, 41: 76-87. doi: 10.3760/cma.j.cn311367-20210104-00007 [6] 谭煌英. 胃神经内分泌肿瘤临床分型的共识和争议[J]. 中华胃肠外科杂志, 2017, 20: 977-981. [7] Delle Fave G, Kwekkeboom DJ, Van Cutsem E, et al. ENETS Consensus Guidelines for the management of patients with gastroduodenal neoplasms[J]. Neuroendocrinology, 2012, 95: 74-87. doi: 10.1159/000335595 [8] Delle Fave G, O'Toole D, Sundin A, et al. ENETS Consensus Guidelines Update for Gastroduodenal Neuroendocrine Neoplasms[J]. Neuroendocrinology, 2016, 103: 119-124. doi: 10.1159/000443168 [9] 徐建明, 梁后杰, 秦叔逵, 等. 中国胃肠胰神经内分泌肿瘤专家共识(2016年版)[J]. 临床肿瘤学杂志, 2016, 21: 927-946. https://www.cnki.com.cn/Article/CJFDTOTAL-LCZL201610013.htm [10] 李洁, 张盼盼. 胃神经内分泌肿瘤的诊治现状[J]. 中国医师进修杂志, 2017, 40: 656-660. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX202302020.htm [11] Domori K, Nishikura K, Ajioka Y, et al. Mucin phenotype expression of gastric neuroendocrine neoplasms: analysis of histopathology and carcinogenesis[J]. Gastric Cancer, 2014, 17: 263-272. doi: 10.1007/s10120-013-0281-7 [12] Pak LM, Yang T, Wang J. Further Classification for Node-Positive Gastric Neuroendocrine Neoplasms[J]. J Gastrointest Surg, 2019, 23: 720-729. doi: 10.1007/s11605-018-3845-3 [13] Gluckman CR, Metz DC. Gastric Neuroendocrine Tumors (Carcinoids)[J]. Curr Gastroenterol Rep, 2019, 21: 13. doi: 10.1007/s11894-019-0684-7 [14] Sansone A, Lauretta R, Vottari S, et al. Specific and Non-Specific Biomarkers in Neuroendocrine Gastroenteropan-creatic Tumors[J]. Cancers (Basel), 2019, 11: 1113. doi: 10.3390/cancers11081113 [15] Filosso PL, Kidd M, Roffinella M, et al. The utility of blood neuroendocrine gene transcript measurement in the diagnosis of bronchopulmonary neuroendocrine tumours and as a tool to evaluate surgical resection and disease progression[J]. Eur J Cardiothorac Surg, 2018, 53: 631-639. doi: 10.1093/ejcts/ezx386 [16] Modlin IM, Kidd M, Bodei L, et al. The clinical utility of a novel blood-based multi-transcriptome assay for the diagnosis of neuroendocrine tumors of the gastrointestinal tract[J]. Am J Gastroenterol, 2015, 110: 1223-1232. doi: 10.1038/ajg.2015.160 [17] Malczewska A, Procner A, Walter A, et al. The NETest liquid biopsy is diagnostic for gastric neuroendocrine tumors: observations on the blood-based identification of microscopic and macroscopic residual diseaseOK[J]. BMC Gastroenterol, 2020, 20: 235. doi: 10.1186/s12876-020-01348-2 [18] van Treijen MJC, Korse CM, van Leeuwaarde RS, et al. Blood Transcript Profiling for the Detection of Neuroendo-crine Tumors: Results of a Large Independent Validation Study[J]. Front Endocrinol (Lausanne), 2018, 9: 740. doi: 10.3389/fendo.2018.00740 [19] Zilli A, Arcidiacono PG, Conte D, et al. Clinical impact of endoscopic ultrasonography on the management of neuroendocrine tumors: lights and shadows[J]. Dig Liver Dis, 2018, 50: 6-14. [20] Kos-Kudła B, Blicharz-Dorniak J, Strzelczyk J, et al. Diagnostic and therapeutic guidelines for gastro-entero-pancreatic neuroendocrine neoplasms (recommended by the Polish Network of Neuroendocrine Tumours)[J]. Endokrynol Pol, 2017, 68: 79-110. doi: 10.5603/EP.2017.0015 [21] Yu R, Wachsman A. Imaging of Neuroendocrine Tumors: Indications, Interpretations, Limits, and Pitfalls[J]. Endocrinol Metab Clin North Am, 2017, 46: 795-814. doi: 10.1016/j.ecl.2017.04.008 [22] Dromain C, de Baere T, Lumbroso J, et al. Detection of liver metastases from endocrine tumors: a prospective comparison of somatostatin receptor scintigraphy, computed tomography, and magnetic resonance imaging[J]. J Clin Oncol, 2005, 23: 70-78. doi: 10.1200/JCO.2005.01.013 [23] Barat M, Soyer P, Al Sharhan F, et al. Magnetic Resonance Imaging May Be Able to Identify the Origin of Neuroendocrine Tumor Liver Metastases[J]. Neuroendocrinology, 2021, 111: 1099-1110. doi: 10.1159/000513015 [24] Inaba Y, Hijioka S, Iwama I, et al. Clinical usefulness of Somatostatin Receptor Scintigraphy in the Diagnosis of Neuroendocrine Neoplasms[J]. Asia Ocean J Nucl Med Biol, 2022, 10: 1-13. [25] Yu J, Li N, Li J, et al. The Correlation Between[(68)Ga]DOTATATE PET/CT and Cell Proliferation in Patients With GEP-NENs[J]. Mol Imaging Biol, 2019, 21: 984-990. doi: 10.1007/s11307-019-01328-3 [26] Carideo L, Prosperi D, Panzuto F, et al. Role of Combined[(68)Ga]Ga-DOTA-SST Analogues and[(18)F]FDG PET/CT in the Management of GEP-NENs: A Systematic Review[J]. J Clin Med, 2019, 8: 1032. doi: 10.3390/jcm8071032 [27] Delpassand ES, Ranganathan D, Wagh N, et al. (64)Cu-DOTATATE PET/CT for Imaging Patients with Known or Suspected Somatostatin Receptor-Positive Neuroendocrine Tumors: Results of the First U.S. Prospective, Reader-Masked Clinical Trial[J]. J Nucl Med, 2020, 61: 890-896. doi: 10.2967/jnumed.119.236091 [28] Johnbeck CB, Knigge U, Loft A, et al. Head-to-Head Comparison of (64)Cu-DOTATATE and (68)Ga-DOTATOC PET/CT: A Prospective Study of 59 Patients with Neuroendocrine Tumors[J]. J Nucl Med, 2017, 58: 451-457. doi: 10.2967/jnumed.116.180430 [29] Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system[J]. Histopathology, 2020, 76: 182-188. doi: 10.1111/his.13975 [30] Zheng X, Guo K, Wasan HS, et al. A population-based study: how to identify high-risk T1 gastric cancer patients?[J]. Am J Cancer Res, 2021, 11: 1463-1479. [31] Shah MH, Goldner WS, Benson AB, et al. Neuroendocr-ine and Adrenal Tumors, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2021, 19: 839-868. doi: 10.6004/jnccn.2021.0032 [32] Daskalakis K, Tsoli M, Karapanagioti A, et al. Recurr-ence and metastatic potential in Type 1 gastric neuroendocr-ine neoplasms[J]. Clin Endocrinol (Oxf), 2019, 91: 534-543. doi: 10.1111/cen.14055 [33] 王玮, 周志伟. 胃神经内分泌肿瘤的外科治疗[J]. 中华胃肠外科杂志, 2021, 24: 849-853. doi: 10.3760/cma.j.cn.441530-20210716-00284 [34] Fukui Y, Kato Y, Okazaki Y, et al. A 3mm Gastric Neuroendocrine Tumor That Metastasized to a Lymph Node[J]. Gan To Kagaku Ryoho, 2018, 45: 1839-1841. [35] Hirasawa T, Yamamoto N, Sano T. Is endoscopic resection appropriate for type 3 gastric neuroendocrine tumors? Retrospective multicenter study[J]. Dig Endosc, 2021, 33: 408-417. doi: 10.1111/den.13778 [36] Chen J, Wang A, Ji K, et al. Comparison of overall survival of gastric neoplasms containing neuroendocrine carcinoma components with gastric adenocarcinoma: a propensity score matching study[J]. BMC Cancer, 2020, 20: 777. doi: 10.1186/s12885-020-07281-7 [37] Stueven AK, Kayser A, Wetz C, et al. Somatostatin Analogues in the Treatment of Neuroendocrine Tumors: Past, Present and Future[J]. Int J Mol Sci, 2019, 20: 3049. doi: 10.3390/ijms20123049 [38] Rinke A, Müller HH, Schade-Brittinger C, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group[J]. J Clin Oncol, 2009, 27: 4656-4663. doi: 10.1200/JCO.2009.22.8510 [39] Vinik AI, Wolin EM, Liyanage N, et al. Evaluation of Lanreotide Depot/Autogel Efficacy and Safety as a Carcinoid Syndrome Treatment (Elect): A Randomized, Double-Blind, Placebo-Controlled Trial[J]. Endocr Pract, 2016, 22: 1068-1080. doi: 10.4158/EP151172.OR [40] Gut P. Oncological management of advanced neuroendocrine tumours (Review)[J]. Mol Clin Oncol, 2020, 13: 8. [41] Lee L, Ito T, Jensen RT. Everolimus in the treatment of neuroendocrine tumors: efficacy, side-effects, resistance, and factors affecting its place in the treatment sequence[J]. Expert Opin Pharmacother, 2018, 19: 909-928. doi: 10.1080/14656566.2018.1476492 [42] Yao JC, Fazio N, Singh S, et al. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study[J]. Lancet, 2016, 387: 968-977. doi: 10.1016/S0140-6736(15)00817-X [43] Yao JC, Shah MH, Ito T, et al. Everolimus for advanced pancreatic neuroendocrine tumors[J]. N Engl J Med, 2011, 364: 514-523. doi: 10.1056/NEJMoa1009290 [44] Yao JC, Lombard-Bohas C, Baudin E, et al. Daily oral everolimus activity in patients with metastatic pancreatic neuroendocrine tumors after failure of cytotoxic chemotherapy: a phase Ⅱ trial[J]. J Clin Oncol, 2010, 28: 69-76. doi: 10.1200/JCO.2009.24.2669 [45] Pavel ME, Hainsworth JD, Baudin E, et al. Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study[J]. Lancet, 2011, 378: 2005-2012. doi: 10.1016/S0140-6736(11)61742-X [46] Hasskarl J. Everolimus[J]. Recent Results Cancer Res, 2018, 211: 101-123. [47] 谈思源, 陈平. 胃肠胰神经内分泌瘤的药物治疗进展[J]. 中华临床医师杂志(电子版), 2016, 10: 2158-2162. doi: 10.3877/cma.j.issn.1674-0785.2016.14.026 [48] Pobłocki J, Jasińska A, Syrenicz A, et al. The Neuroendocrine Neoplasms of the Digestive Tract: Diagnosis, Treatment and Nutrition[J]. Nutrients, 2020, 12: 1437. doi: 10.3390/nu12051437 [49] Garcia J, Hurwitz HI, Sandler AB, et al. Bevacizumab (AvastinⓇ) in cancer treatment: A review of 15 years of clinical experience and future outlook[J]. Cancer Treat Rev, 2020, 86: 102017. doi: 10.1016/j.ctrv.2020.102017 [50] Boyce M, Moore AR, Sagatun L, et al. Netazepide, a gastrin/cholecystokinin-2 receptor antagonist, can eradicate gastric neuroendocrine tumours in patients with autoimmune chronic atrophic gastritis[J]. Br J Clin Pharmacol, 2017, 83: 466-475. doi: 10.1111/bcp.13146 [51] Moore AR, Boyce M, Steele IA, et al. Netazepide, a gastrin receptor antagonist, normalises tumour biomarkers and causes regression of type 1 gastric neuroendocrine tumours in a nonrandomised trial of patients with chronic atrophic gastritis[J]. PLoS One, 2013, 8: e76462. doi: 10.1371/journal.pone.0076462 [52] Lania A, Ferraù F, Rubino M, et al. Neoadjuvant Therapy for Neuroendocrine Neoplasms: Recent Progresses and Future Approaches[J]. Front Endocrinol (Lausanne), 2021, 12: 651438. [53] Yamamoto M, Ozawa S, Koyanagi K, et al. Effectiveness of neoadjuvant chemotherapy with etoposide and cisplatin followed by surgery for esophageal neuroendocrine carcinoma: a case report[J]. J Thorac Dis, 2018, 10: E450-E455. [54] Ogawa H, Tanaka Y, Kitamura Y, et al. Efficacy of perioperative chemotherapy for pulmonary high-grade neuroendocrine carcinomas: a propensity score matching analysis[J]. J Thorac Dis, 2019, 11: 1145-1154. [55] Tang H, Wang H, Xi S, et al. Perioperative chemotherapy with pemetrexed and cisplatin for pulmonary large-cell neuroendocrine carcinoma: a case report and literature review[J]. Onco Targets Ther, 2018, 11: 2557-2563. [56] Borga C, Businello G, Murgioni S, et al. Treatment personalization in gastrointestinal neuroendocrine tumors[J]. Curr Treat Options Oncol, 2021, 22: 29. [57] Strosberg J, El-Haddad G, Wolin E, et al. Phase 3 Trial of (177)Lu-Dotatate for Midgut Neuroendocrine Tumors[J]. N Engl J Med, 2017, 376: 125-135. [58] Paganelli G, Sansovini M, Nicolini S, et al. (177)Lu-PRRT in advanced gastrointestinal neuroendocrine tumors: 10-year follow-up of the IRST phase Ⅱ prospective study[J]. Eur J Nucl Med Mol Imaging, 2021, 48: 152-160. [59] Yordanova A, Wicharz MM, Mayer K, et al. The Role of Adding Somatostatin Analogues to Peptide Receptor Radionuclide Therapy as a Combination and Maintenance Therapy[J]. Clin Cancer Res, 2018, 24: 4672-4679. [60] Minczeles NS, Hofland J, de Herder WW, et al. Strategies Towards Improving Clinical Outcomes of Peptide Receptor Radionuclide Therapy[J]. Curr Oncol Rep, 2021, 23: 46. -
点击查看大图
表(3)
计量
- 文章访问数: 322
- HTML全文浏览量: 57
- PDF下载量: 66
- 被引次数: 0
