Digestive and Liver Disease Unit, S. Andrea Hospital, ENETs Center of Excellence, Rome, Italy; Pancreato-biliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, ENETs Center of Excellence, San Raffaele Scientific Institute IRCCS, Milan, Italy.
Department of Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Dig Liver Dis. 2019 Dec;51(12):1725-1730. doi: 10.1016/j.dld.2019.07.011. Epub 2019 Aug 9.
Factors associated with rectal NENs prognosis are poorly investigated.
To evaluate the prognostic role of the ENETs staging and grading systems in rectal NENs.
Tertiary referral, multicenter, retrospective study. Factors associated with OS and PFS were investigated by Cox-regression analysis, with best size cut-offs calculated by ROC analysis.
Of 100 patients (mean age 55, 45% male, mean size 16.2 mm) 62, 5, 10 and 23 were TNM stage 1 to 4, and 63, 15 and 22 were G1, G2 and G3. Primary treatment was endoscopic snare resection in 62%, endoscopic mucosal resection/endoscopic submucosal dissection in 10%, surgery in 20% and medical treatment in 8%. The best size cut-offs to predict OS and PFS were 10 and 12 mm. During a mean follow-up of 40.7 months 12% died and 26% progressed. The 5-year OS and PFS were 79.5% and 65.2%. Stage IV and G3 were associated with worse OS (HR 8.16; p = 0.002; HR 15.57; p = 0.0004) and PFS (HR 14.26 p < 0.0001; HR 6.42; p = 0.0007).
Both staging and grading accurately predict rectal NENs prognosis. Size alone has limited accuracy as 26% of patients with stage IV and 16% with G3 have a primary tumour≤10 mm.
与直肠神经内分泌肿瘤（NENs）预后相关的因素尚未得到充分研究。
评估 ENETS 分期和分级系统在直肠 NENs 中的预后作用。
这是一项三级转诊、多中心、回顾性研究。采用 Cox 回归分析评估与 OS 和 PFS 相关的因素，并通过 ROC 分析计算最佳大小截断值。
100 例患者中（平均年龄 55 岁，45%为男性，平均肿瘤大小为 16.2mm），62 例为 TNM 分期 1 至 4 期，63 例、15 例和 22 例分别为 G1、G2 和 G3 级。主要治疗方法为内镜圈套切除术（62%）、内镜黏膜切除术/内镜黏膜下剥离术（10%）、手术（20%）和药物治疗（8%）。预测 OS 和 PFS 的最佳大小截断值分别为 10 和 12mm。在平均随访 40.7 个月后，有 12%的患者死亡，26%的患者进展。5 年 OS 和 PFS 分别为 79.5%和 65.2%。IV 期和 G3 级与较差的 OS（HR 8.16；p=0.002；HR 15.57；p=0.0004）和 PFS（HR 14.26，p<0.0001；HR 6.42；p=0.0007）相关。
分期和分级均能准确预测直肠 NENs 的预后。仅肿瘤大小的准确性有限，因为 26%的 IV 期患者和 16%的 G3 级患者的原发肿瘤直径≤10mm。
