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目的 分析影响直肠神经内分泌肿瘤(neuroendocrine neoplasia, NEN)预后的临床因素。 方法 回顾性收集2012年5月至2019年9月北京协和医院门诊结直肠NEN前瞻性数据库中确诊为直肠NEN并在基本外科行手术治疗的患者资料, 包括一般资料、手术方式、病理诊断结果及随访信息。采用Kaplan-Meier生存分析, 比较患者临床因素与预后的关系。 结果 共130例符合纳入和排除标准的患者入选本研究, 其中男性71例(54.6%), 女性59例(45.4%)。102例术后病理有明确世界卫生组织分级, G1、G2、G3级患者分别为82例、18例、2例。122例行局部切除手术, 9例行根治性手术(其中1例先行局部切除手术后行根治性手术)。7例患者存在淋巴结转移, 均为接受根治性手术患者。116例患者完成随访, 其中4例出现复发或转移, 2例死于NEN转移。Kaplan-Meier分析显示, 接受根治性手术较局部切除手术、出现淋巴结转移较未出现淋巴结转移、病灶≥ 2 cm较病灶1~ < 2 cm或 < 1 cm患者的无复发生存率更低(P均 < 0.05)。 结论 病灶≥ 2 cm、淋巴结转移是直肠NEN患者预后不良的危险因素, 此类患者应除外远处转移后行根治性手术, 术后密切随访。 Abstract:Objective The aim of this study was to analyze the factors affecting the prognosis of rectal neuroendocrine neoplasia (NEN). Methods The clinical data were retrospectively collected in patients with rectal NEN who were diagnosed and surgically treated in the Department of General Surgery at Peking Union Medical College Hospital from May 2012 to September 2019. Patients suffering from distant organ metastases and rectal adenocarcinoma at the initial diagnosis were excluded. Kaplan-Meier analysis was used to assess the influence of general information, surgical methods, pathology, etc. on the disease-free survival. Results A total of 130 patients with rectal NEN were enrolled, and 102 patients had a clear WHO classification. Among them, G1, G2, and G3 had 82, 18, and 2 patients, respectively. A total of 122 patients underwent local resection and 9 patientsunderwent radical surgery. One patient underwent remedial radical surgery after local resection. Lymph node metastasis was found in 7 patients, and all of them underwent radical surgery. Follow-up was performed on 116 patients, 4 of whom had recurrence or metastasis, and 2 died of NEN metastasis. Kaplan-Meier analysis showed that patients with radical surgery, lesions ≥ 2 cm, and lymph node metastasis had a lower rate of recurrence-free survival(all P < 0.05). Conclusions Patients with rectal NEN who had a lesion ≥ 2 cm or metastatic lymph nodes may have a poorer prognosis. Radical surgery should be actively performed for these patients after cautious evaluation to exclude distant metastases, and a close follow-up should also be performed after surgery. 利益冲突 无 -
表 1 130例直肠NEN患者一般临床资料
临床资料 例数(%) 性别 男 71(54.6) 女 59(45.4) 年龄 ＜60岁 98(75.4) ≥60岁 32(24.6) 手术方式 TEM 99(76.2) 经肛门直肠肿物局部切除术 23(17.7) Dixon术 6(4.6) Parks术 1(0.8) Miles术 1(0.8） WHO分级 G1 82(63.1) G2 18(13.8） G3 2(1.5) 未分级 28(21.5） 病灶大小 ＜1 cm 97(74.6) 1~＜2 cm 25(19.2) ≥2 cm ≥8(6.2) NEN：神经内分泌肿瘤；TEM：经肛门内镜显微手术 
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