Division of Gastroenterology, Department of Medicine, Mount Sinai School of Medicine, New York, N.Y., USA.
Neuroendocrinology. 2013;98(3):180-7. doi: 10.1159/000355612. Epub 2013 Nov 5.
Rectal neuroendocrine tumors (NETs) are among the most common NETs. The aim was to validate European Neuroendocrine Tumor Society (ENETS)/North American Neuroendocrine Tumor Society (NANETS) staging and grading systems with regard to clinical outcomes.
A comprehensive database was constructed from existing databases of the Mount Sinai Division of Gastrointestinal Pathology and the Carcinoid Cancer Foundation. Analysis was performed on 141 patients identified with rectal NETs seen at Mount Sinai Hospital between 1972 and 2011.
The median age was 52.7 years; 43% were males. Average tumor size was 0.88 cm. NETs <1 cm accounted for 75.6% of the tumors. Stage I, II, III and IV accounted for 79.4, 2.8, 5.0 and 12.8% of the tumors, respectively. G1 tumors accounted for 88.1%, G2 8.3% and G3 3.6%. Of G1 tumors, 94.6% were stage I and 5.4% were stage IV. The median survival time for all 141 patients was 6.8 years (range, 0.8-34.7 years). The overall 5-year survival rate was 84.4%. The 5-year survival rates for patients in stages I-IV were 92.7, 75.0, 42.9 and 33.2%, respectively. The 5-year survival rates for patients with G1-G3 tumors were 87.7, 47.6 and 33.3%, respectively. Univariate analysis of increased survival showed significance for lower stage, lower grade, smaller size, absence of symptoms and endoscopically treated tumors. Multivariate analysis showed that stage alone was statistically significant as the strongest predictor of survival.
The results of our study validated ENETS/NANETS guidelines for staging and grading of rectal NETs in the US setting of a tertiary referral center. Staging according to ENETS/NANETS guidelines should be used in the treatment algorithm rather than size alone.
直肠神经内分泌肿瘤（NETs）是最常见的 NETs 之一。本研究旨在验证欧洲神经内分泌肿瘤学会（ENETS）/北美神经内分泌肿瘤学会（NANETS）分期和分级系统与临床结局的相关性。
从西奈山胃肠病学病理学系和类癌癌症基金会的现有数据库中构建了一个综合数据库。对 1972 年至 2011 年间在西奈山医院就诊的 141 例直肠 NET 患者进行了分析。
中位年龄为 52.7 岁；43%为男性。平均肿瘤大小为 0.88cm。<1cm 的 NET 占肿瘤的 75.6%。I、II、III 和 IV 期分别占肿瘤的 79.4%、2.8%、5.0%和 12.8%。G1 肿瘤占 88.1%，G2 占 8.3%，G3 占 3.6%。G1 肿瘤中，94.6%为 I 期，5.4%为 IV 期。141 例患者的中位总生存期为 6.8 年（范围 0.8-34.7 年）。总体 5 年生存率为 84.4%。I-IV 期患者的 5 年生存率分别为 92.7%、75.0%、42.9%和 33.2%。G1-G3 肿瘤患者的 5 年生存率分别为 87.7%、47.6%和 33.3%。单因素分析显示，较低的分期、分级、较小的肿瘤大小、无症状和内镜治疗的肿瘤与生存率的提高显著相关。多因素分析显示，分期是生存的最强预测因素，具有统计学意义。
本研究结果验证了 ENETS/NANETS 指南在我们的美国三级转诊中心的直肠 NET 分期和分级中的应用。在治疗算法中应使用 ENETS/NANETS 指南进行分期，而不仅仅是肿瘤大小。
