直肠神经内分泌肿瘤69例淋巴结转移和预后的影响因素分析

目的研究影响直肠神经内分泌肿瘤（NET）的淋巴结转移及预后因素。方法回顾性分析2003年4月至2011年10月辽宁省肿瘤医院大肠外科收治的69例直肠NET患者的临床资料，分析淋巴结转移及预后与直肠NET临床病理因素的关系。结果69例患者中有9例（13．0％）发生淋巴结转移，单因素分析结果显示：淋巴结转移与直肠NET大小、T分期及G分级有关（均P〈0．01）；多因素分析结果显示：T分期是独立影响淋巴结转移的因素（P=0．002，OR=46．000，95％CI：4．030～525．126）。全组患者的5年总生存率为90．3％，单因素分析结果显示：肿瘤大小、T分期、N分期、M分期、TNM分期及G分级与患者的总体生存率有关（分别为P〈0．01和P〈0．05）；多因素分析结果显示，M分期是长期生存的独立预后因素（P=0．000，HR=2．285，95％CI：1．484～3．518）。TNM分期Ⅰ期行局部和根治切除手术的患者，3年总生存率差异无统计学意义（P〉0．05）；Ⅱ期及以上分期患者，行非根治切除与根治切除手术者3年总生存率差异则有统计学意义（P=0．046）。结论直肠NET的T分期与淋巴结转移有关，TNM与M分期两者交互作用影响患者的预后，故可以作为淋巴结转移及预后的预测因素。TNM分期Ⅰ期的患者推荐行局部切除，Ⅱ期及以上的患者推荐行根治性手术治疗。

Risk factors associated with lymph node metastasis and prognosis in 69 patients with rectal neuroendocrine tumors

Objective To investigate risk factors associated with lymph node metastasis and prognosis of rectal neuroendocrine tumor （NET）. Methods Clinicopathological data of 69 patients with rectal NET in our department from April 2003 to October 2011 were retrospectively analyzed. Associations of clinicopothological factors with lymph node metastasis and prognosis were examined using univariate and multivariate analysis. Results Of the 69 patients, 9 cases had lymph node metastasis. The lymph node metastasis was significantly associated with tumor size, T stage and G grade by univariate analysis. Multivariate analysis showed that T stage was the only risk factor associated with lymph node metastasis. The overall 5-year survival rate was 90.3%. Prognosis of rectal NET was significantly associated with tumor size, T stage, N stage, M stage, TNM stage and G grade by univariate analysis. Multivariate analysis showed that M stage was significantly associated with long-term survival in rectal NET patients （P=0.000, HR =2.285, 95%CI： 1.484-3.518）. There was no significant difference in patients with stage Ⅰ between local and radical resection, while there were significant differences in those with stage Ⅱ or higher between the two operations （P=0.046）. Conclusion T stage is associated with lymph node metastasis and both TNM stage and M stage can affect the prognosis of patients with NET, which may be used as potential predictive factors for rectal NET. Local resection should be recommended for patients with stage Ⅰ and radical resection should be recommended for patients with stage Ⅱ or higher.