Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Endoscopy. 2021 Jul;53(7):702-709. doi: 10.1055/a-1274-0161. Epub 2020 Dec 16.
The clinical significance of the endoscopic appearance of rectal neuroendocrine tumors (NETs) is poorly understood. We aimed to develop a novel scoring system based on endoscopic appearances to predict endoscopically advanced disease in patients with rectal NETs when initially diagnosed.
Patients diagnosed with well-differentiated rectal NETs between January 2005 and December 2019 were retrospectively included. Logistic regression analyses were applied to study the relationship between endoscopic appearance and advanced disease. The whole dataset was randomly divided into training and validation sets, which were used to develop and validate a novel scoring system, respectively.
309 patients were included. The endoscopic appearance of rectal NETs was significantly associated with advanced disease ( < 0.001). A novel scoring system was developed based on endoscopic appearance, including tumor size, tumor shape, and mucosal surface, using the training set. The area under curve (AUC) of the scoring system to predict advanced disease was 0.953 (95 % confidence interval [CI] 0.915 - 0.991; < 0.001) and 0.960 (95 %CI 0.905 - 1.000; < 0.001) in the training and validation sets, respectively. Furthermore, the scoring system was significantly associated with tumor grade. Patients with high scores had significantly worse disease-free and overall survival than patients with low scores ( < 0.001).
This novel scoring system based on the endoscopic appearance of the primary tumor can help to accurately identify patients with endoscopically advanced disease who are not suitable for endoscopic resection. In addition, it is of great value in monitoring tumor recurrence and overall survival in patients with rectal NETs.
直肠神经内分泌肿瘤（NET）的内镜表现的临床意义尚未被充分了解。我们旨在开发一种基于内镜表现的新型评分系统，以预测初次诊断时直肠 NET 患者内镜下进展性疾病。
回顾性纳入 2005 年 1 月至 2019 年 12 月期间诊断为分化良好的直肠 NET 的患者。应用逻辑回归分析研究内镜表现与进展性疾病之间的关系。整个数据集被随机分为训练集和验证集，分别用于开发和验证新型评分系统。
共纳入 309 例患者。直肠 NET 的内镜表现与进展性疾病显著相关（ < 0.001）。我们使用训练集基于内镜表现（包括肿瘤大小、肿瘤形状和黏膜表面）开发了一种新型评分系统。该评分系统预测进展性疾病的曲线下面积（AUC）在训练集和验证集中分别为 0.953（95%置信区间 0.915-0.991； < 0.001）和 0.960（95%置信区间 0.905-1.000； < 0.001）。此外，该评分系统与肿瘤分级显著相关。高评分患者的无病生存和总生存明显差于低评分患者（ < 0.001）。
基于原发肿瘤内镜表现的新型评分系统有助于准确识别不适合内镜切除的内镜下进展性疾病患者。此外，该评分系统在监测直肠 NET 患者肿瘤复发和总生存方面具有重要价值。
