Prognosis of the Neuroendocrine Tumors of the Colon and Rectum with Lymph Node Metastasis after Surgical Treatment with or without Adjuvant Therapy

大腸直腸神經內分泌瘤合併淋巴轉移術後接受輔助性治療的預後

黃聖捷(Sheng-Chieh Huang) ； 林楨國(Jen-Kou Lin) ； 姜正愷(Jeng-Kai Jiang) ； 林資琛(Tzu-Chen Lin) ； 陳維熊(Wei-Shone Chen) ； 楊純豪(Shung-Haur Yang) ； 唐瑞平(Rei-Ping Tang) ； 江支銘(Jy-Ming Chiang) ； 蔡文司(Wen-Sy Tsai) ； 葉建裕(Chien-Yuh Yeh) ； 游正府(Jeng-Fu You) ； 陳進勛(Jinn-Siun Chen)

《中華民國大腸直腸外科醫學會雜誌》 27卷1期 (2016/03) Pp. 29-35

https://doi.org/10.6312/SCRSTW.2016.27(1).10417

摘要

目的：大腸直腸神經內分泌瘤是很罕見的大腸直腸疾病，而且和傳統上所認知的大腸直腸癌有著不一樣的特性。這種神經內分泌瘤的治療主要都是靠外科手術切除，但若是術後發現有淋巴轉移時，該不該採取輔助性的治療目前還未定論，臨床上的證據也不多。這個研究主要探究大腸直腸神經內分泌瘤合併淋巴轉移在台灣的治療現狀，比較手術後是否有輔助性治療的預後。方法：從林口長庚和台北榮總兩家醫學中心1995年到2015年間，大腸直腸神經內分泌瘤合併淋巴轉移接受手術治療的案例一共是17人。回朔性地回顧這些病人的臨床症狀，病理切片，治療方針和癒後，將資料統計分析並比較其中的差異並加以呈現。結果：世界衛生組織（WHO）在2010年將大腸直腸的神經內分泌瘤依據病理的細胞分化區分成三種程度。統計發現這17人的預後（大腸直腸神經內分泌瘤合併淋巴轉移經手術治療後）和WHO的分類是有相關性的（p ＜ 0.001）。而其他的因素像是這些病人腫瘤的大小和侵犯程度，術後是否接受輔助性治療，來自大腸或是直腸的內分泌瘤，都不會影響這些病人疾病的預後。結論：大腸直腸的內分泌瘤是很少見的大腸直腸腫瘤，在這個研究案例中，這些腫瘤如果合併有淋巴轉移，在接受手術切除後其預後和WHO的腫瘤分類是有統計上的相關性的。而手術後儘管發現有淋巴的轉移，術後有沒有接受輔助性治療並不會影響疾病的預後。然而這個結論仍需更進一步的案例收集和前瞻性的研究來加以確認。

關鍵字

大腸直腸的內分泌瘤 ； 淋巴轉移 ； 輔助性治療

並列摘要

Purpose. Neuroendocrine tumor (NET) of the colon and rectumis rare and is different from the way of treatment of the so-called colorectal cancer. The treatment of the NET of the colon and rectum is mainly based on the endoscopic or surgical resection. However, the adjuvant therapy beyond the resection to the advanced disease is still not standardizedand there is little evidence discussion about it. Theaim of the study is to review the outcome of the advanced neuroendocrine tumor of the colon and rectum with or without adjuvant therapy in two medical centers in Taiwan. Methods. From 1995 to 2015, a totalof seventeen patients with NET of the colon and rectum with lymph node metastasis without distant metastasis were enrolled in this case serie. The clinical symptoms, lab data, pathology result and treatment were reviewed and disease survival was obtained for further evaluation. Results. In 2010, WHO divided the NET into three categories according to the cell proliferation by the pathology. In our case series (NET of the colon and rectum with lymph node metastasis, TMN stage IIIb), the disease survival is correlated with the WHO 2010 classification (p ＜ 0.001). Others factors including T stage, adjuvant therapy, location of the NET have no significance difference between the disease survivals. Conclusion. NET of the colon and rectum is rare and the prognosis of tumor with lymph node metastasis after surgical treatment depends on the 2010 WHO classification according to the tumor cell differentiation. There is no apparent benefit from adjuvant therapy after surgical treatment with curative intent in our case series. Further case collection and a prospective study are needed to confirm the treatment options of NET of the colon and rectum.

並列關鍵字

Neuroendocrine tumors of the colon and rectum ； Lymph node metastasis ； Adjuvant therapy

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