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目的探讨伴神经内分泌细胞分化(neuroendocrine cell differentiation,NED)结直肠癌的临床病理特点、治疗方法及预后。方法回顾性分析军医进修学院解放军总医院2005～2010年收治的16例伴神经内分泌分化结直肠癌病例的临床资料。结果本组16例患者中,5例发生于直肠,4例位于升结肠,3例位于回盲部,2例位于乙状结肠,1例位于横结肠,1例位于降结肠。根据2010年WHO消化系统肿瘤分类新标准,重新阅片复习本组19例患者均为结直肠癌伴神经内分泌分化特征。临床无明显特异性表现,其诊断主要依靠病理及免疫组织化学检查。16例患者均接受手术治疗,手术采用根治性切除术或肠部分切除术。2例伴肝转移者,其中1例于术前行肝动脉栓塞化疗术(TACE);另一例因肝脏弥漫性转移及双肺转移,仅行姑息性部分肠切除及造瘘术。所有患者术后均接受化疗。本组患者1年生存率为73%。结论结直肠癌伴神经内分泌分化好发于直肠,但可发生于结直肠的任何部位。免疫组织化学染色对该病的诊断具有重要价值。本病总体预后不佳,治疗应尽可能行根治性切除术,并选择合适的术后治疗方案。
Objective To investigate the clinicopathological features, treatment and prognosis of neuroendocrine cell differentiation (NED) colorectal cancer. Methods The clinical data of 16 patients with neuroendocrine differentiation colorectal cancer who were admitted to PLA PLA General Hospital from 2005 to 2010 were retrospectively analyzed. Results Of the 16 patients, 5 occurred in the rectum, 4 in the ascending colon, 3 in the ileocecal region, 2 in the sigmoid colon, 1 in the transverse colon, and 1 in the descending colon. According to the WHO 2010 classification of new digestive system tumors, re-read the review of this group of 19 patients with colorectal cancer with neuroendocrine differentiation characteristics. No specific clinical manifestations, the diagnosis depends mainly on pathology and immunohistochemistry. All 16 patients underwent surgery, with radical resection or partial gastrectomy. Two patients with liver metastases, including one undergoing preoperative hepatic artery chemoembolization (TACE); the other due to diffuse metastasis of the liver and lung metastases, only partial palliative resection and fistulation. All patients received chemotherapy after surgery. The 1-year survival rate of patients in this group was 73%. Conclusion Colorectal cancer with neuroendocrine differentiation occur in the rectum, but can occur in any part of the colorectal. Immunohistochemical staining for the diagnosis of the disease has important value. The poor overall prognosis of the disease, the treatment should be radical radical resection, and select the appropriate postoperative treatment.