Gastric Mixed Adenoneuroendocrine Carcinoma Research Articles

Clinicopathological features of gastric mixed adenoneuroendocrine carcinoma

Clinicopathological features of gastric mixed adenoneuroendocrine carcinoma

Assessment value of preoperative platelet-lymphocyte ratio in the prognosis of patients with gastric mixed adenoneuroendocrine carcinoma

To explore the prognostic assessment value of preoperative blood platelet-lymphocyte ratio (PLR) in patients with gastric mixed adenoneuroendocrine carcinoma (gMANEC) treated with radical surgery. Clinical and pathological data of 84 gMANEC patients who underwent radical resection from 2006 to 2016 in Department of Gastric Surgery, Fujian Medical University Union Hospital were analyzed retrospectively. Receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the PLR for predicting prognosis. The Cox proportional hazards regression model was used to identify prognostic factors of gMANEC. All the patients underwent D2 lymph node dissection, including 26 cases of distal subtotal gastrectomy and 58 cases of total gastrectomy. The postoperative pathological TNM stage system(pTNM) demonstrated that the patients of stage I(, II(, and III( were 9(10.7%), 14(16.7%), and 61(72.6%) cases, respectively. The median follow-up time was 40(3 to 96) months. The recurrence rate was 41.7%(35/84). The median time to recurrence was 10 (1 to 40) months, and 82.9%(29/35) patients experienced recurrence within the first 2 years after operation. The median overall survival time was 27(3 to 39) month, and the median recurrence-free survival time was 21 (1 to 96) months. The 1-, 3-, and 5-year overall survival(OS) rates were 87.6%, 56.6%, and 47.4%, respectively, and the 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 70.5%, 50.7%, and 44.9%, respectively. The best cutoff value of the PLR for predicting prognosis was 133 through ROC curve, which categorized all the patients into low PLR group (≤133) comprising 28 patients and high PLR group (>133) comprising 56 patients. The tumor recurrence rate was significantly higher in high PLR group (50.0%, 28/56) than that in low PLR group(25.0%, 7/28)(P=0.028). The live metastasis rate was significantly higher in high PLR group(35.7%, 20/56) than that in low PLR group(10.7%, 3/28)(P=0.015). Cox regression analysis showed that only pTNM stage (P=0.003) was independent prognostic factors of OS, while both pTNM stage (P=0.000) and blood PLR (P=0.015) were independent prognostic factors of RFS. gMANEC patients with high preoperative PLR tend to present recurrence and metastasis, especially to present live metastasis, so they should be kept under surveillance more frequently after surgery.

Gastric mixed adenoneuroendocrine carcinoma: correlation of histologic characteristics with prognosis.

Gastric mixed adenoneuroendocrine carcinomas (MANECs) are rare, with both the exocrine and neuroendocrine components exceeding 30% volume. Several classifications for MANECs have been proposed, yet they have not been clinically evaluated. The aim of this study was to evaluate the correlation between tumor grade, histologic characteristics, and prognosis of gastric MANECs. We collected eligible 14 cases in our series and 31 cases in the literature and compared the prognostic difference among gastric MANECs with different histologic characteristics. Gastric MANECs could be divided into subgroups according to tumor grade of the neuroendocrine component and adenocarcinoma types. The high grade and large proportion of neuroendocrine component correlated with aggressive behavior and a tendency of poor clinical outcome. Gastric MANECs with a poorly differentiated adenocarcinoma showed a significant lower survival rate than did MANECs with a differentiated adenocarcinoma or mucin-producing carcinoma (P = .0008). Gastric MANECs were a heterogeneous group with different tumor grades, histologic subtypes, combination patterns, and patient outcomes. Previous classifications were evaluated. This study proves that histologic characteristics correlate with clinical outcomes. Our findings are complements to the latest prognostic classification.

Prognostic value of (18)F-fluorodeoxyglucose positron emission tomography in patients with gastric neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma.

Gastric neuroendocrine carcinomas (NEC) and mixed adenoneuroendocrine carcinoma (MANEC) are very rare, aggressive tumors of the stomach. We aimed to examine predictive role of pretreatment (18)F-FDGPET/CT-assessed metabolic parameter of primary tumors and metastases in patientswith gastric NEC and MANEC. We conducted a review of the 27 patients with histopathologically confirmed NECs (n=10) and MANEC (n=17) of thestomachat our institution between January 2005 and December 2012. All patients underwent (18)F-FDG-PET examination at diagnosis. Metabolic parameters [SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] of the primary tumor and metastases on baseline PET/CT were analyzed. The median follow-up duration was 39.4months (95% CI 20.0-58.1months) and the median overall survival (OS) was 25.7months (95% CI 14.1-37.2months). All gastric lesions were well visualized (average SUVmax=12.0, range 3.0-41.8). When subjects were divided into two groups by ROC cut-off value of 210.9 and 612, patients with high TLG in primary lesion and metastases showed poorer prognosis compared to low TLG patients (P=0.09, P=0.002, respectively). In the sub-analysis of patients with metastasis (n=12), patients with high TLG in whole body tumor showed significantly shorter OS compared to those with low TLG (31.7±11.4 vs. 7.2±2.1months, P=0.006). (18)F-FDG PET/CT is useful in evaluating prognosis of advanced gastric cancer with neuroendocrine carcinoma components. Baseline MTV of primary gastric cancer with metastatic disease, and MTV, TLG of metastases may be prognostic markers in patients with gastric NEC and MANEC.

Gastric Mixed Adenoneuroendocrine Carcinoma with Squamous Differentiation: A Case Report.

The occurrence of gastric mixed adenoneuroendocrine carcinoma (MANEC) is relatively rare, although a few cells of gastric adenocarcinoma frequently show neuroendocrine differentiation [1]. We herein present one of only a few reported cases of gastric MANEC with trilineage histologic differentiation, composed of adenocarcinoma, large cell neuroendocrine carcinoma (NEC), and squamous cell carcinoma (SqCC).