Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Gastrointest Endosc. 2019 Mar;89(3):602-606. doi: 10.1016/j.gie.2018.11.010. Epub 2018 Nov 14.
Prevalence of rectal carcinoids is increasing, partly because of increased colorectal cancer screening. Local excision (endoscopic or transanal excision) is usually performed for small (<1-2 cm) rectal carcinoids, but data on clinical outcomes from large population-based U.S. studies are lacking. The aims of this study were to determine the prevalence of metastasis of resected small rectal carcinoid tumors using a large national cancer database and to evaluate the long-term survival of patients after local resection as compared with radical surgery.
The Surveillance Epidemiology and End Results database was used to identify 788 patients with rectal T1 carcinoids <2 cm in size. Prevalence of metastases at initial diagnosis and risk factors for metastases were analyzed. Cancer-specific survival (CSS) was calculated.
A total of 727 patients (92.3%) had tumors ≤10 mm in diameter and 61 (7.7%) had tumors 11 to 19 mm. Overall, 12 patients (1.5%) had metastasis at the time of diagnosis with prevalence of 1.1% in lesions ≤10 mm and 6.6% in lesions 11 to 19 mm (P = .01). Survival of patients with T1 rectal carcinoids without metastasis was significantly better than those with metastasis (5-year CSS of 100% vs 78%, P < .001). Of 559 patients with T1N0M0 rectal carcinoids ≤10 mm, 5-year CSS was 100% in both groups who underwent local excision and those who underwent radical surgery.
Larger T1 rectal carcinoid tumors (11-19 mm) have significantly higher risk of lymph node metastases compared with those ≤10 mm. Survival is worse with metastatic disease. Local therapy is adequate for T1N0M0 rectal carcinoids ≤10 mm in size with excellent long-term outcomes.
直肠类癌的患病率正在上升，部分原因是结直肠癌筛查的增加。对于直径小于 1-2cm 的小直肠类癌，通常采用局部切除（内镜下或经肛门切除），但缺乏来自美国大型人群研究的关于临床结果的数据。本研究的目的是使用大型国家癌症数据库确定切除的小直肠类癌肿瘤的转移率，并评估局部切除与根治性手术相比患者的长期生存情况。
使用监测、流行病学和最终结果数据库确定了 788 名大小<2cm 的直肠 T1 类癌患者。分析了初诊时转移的患病率和转移的危险因素。计算了癌症特异性生存率（CSS）。
共有 727 名（92.3%）患者肿瘤直径≤10mm，61 名（7.7%）患者肿瘤直径为 11-19mm。总体而言，12 名患者（1.5%）在诊断时发生转移，病变直径≤10mm 的转移率为 1.1%，病变直径为 11-19mm 的转移率为 6.6%（P=0.01）。无转移的 T1 直肠类癌患者的生存明显优于有转移的患者（5 年 CSS 为 100%对 78%，P<0.001）。在 559 名直径≤10mm、T1N0M0 直肠类癌患者中，行局部切除和根治性手术的两组患者 5 年 CSS 均为 100%。
直径较大的 T1 直肠类癌（11-19mm）与直径较小的类癌相比，淋巴结转移的风险明显更高。患有转移性疾病的患者预后较差。对于直径≤10mm 的 T1N0M0 直肠类癌，局部治疗是充分的，且长期预后良好。
