Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, 35043, Baldingerstrasse Marburg, Germany.
Department of Gastroenterology and Endocrinology, Philipps-University Marburg, Marburg, Germany.
World J Surg. 2021 Apr;45(4):1109-1117. doi: 10.1007/s00268-020-05884-6. Epub 2021 Jan 8.
Small intestinal neuroendocrine neoplasms (SI-NEN) are rare, and only about 40% of patients are diagnosed without distant metastases. Aim of the study was to identify prognostic factors in patients with potentially curative resected locoregional SI-NEN.
Patients with curative resected locoregional SI-NEN (ENETS stages I-III) were retrieved from a prospective data base. Demographic, surgical and pathological data of patients with and without disease recurrence were retrospectively analyzed using univariate and multivariate analysis.
In a 20-year period, 65 of 203 (32%) patients with SI-NEN were operated for stages I-III disease. Thirty-eight (58.5%) patients were men, and the median age at surgery was 59 (range 37-87) years. After median follow-up of 65 months, 14 patients experienced disease relapse median 28.5 (range 6-122) months after initial surgery, of which 2 died due to their disease. Multivariate analysis revealed age ≥ 60 years (HR = 6.41, 95% CI 1.38-29.67, p = 0.017), tumor size ≥ 2 cm (HR = 26.54, 95% CI 4.46-157.62, p < 0.001), lymph node ratio > 0.5 (HR 7.18, 95% CI 1.74-29.74, p = 0.007) and multifocal tumor growth (HR = 6.98, 95% CI 1.66-29.39, p = 0.008) as independent negative prognostic factors and right hemicolectomy compared to segmental small bowel resection (HR = 0.04, 95% CI 0.01-0.24, p < 0.001) as independent protector against recurrence.
Patients with locoregional SI-NEN with an age ≥ 60 years, tumor size ≥ 2 cm, lymph node ratio > 0.5 and multiple small bowel tumor foci have an increased risk for recurrence and might benefit from adjuvant treatment. In contrast, right hemicolectomy of ileal SI-NEN seems to reduce the risk of recurrence.
小肠神经内分泌肿瘤（SI-NEN）较为罕见，仅有约 40%的患者在诊断时无远处转移。本研究旨在明确可根治性切除的局部区域 SI-NEN 患者的预后因素。
从一个前瞻性数据库中检索出接受根治性切除的局部区域 SI-NEN（ENETS 分期 I-III 期）患者。回顾性分析无疾病复发和有疾病复发患者的人口统计学、手术和病理数据，采用单因素和多因素分析。
在 20 年期间，203 例 SI-NEN 患者中有 65 例接受了 I-III 期手术。38 例（58.5%）为男性，手术时的中位年龄为 59 岁（范围 37-87 岁）。在初始手术后中位随访 65 个月后，14 例患者出现疾病复发，中位复发时间为 28.5 个月（范围 6-122 个月），其中 2 例患者死于疾病。多因素分析显示，年龄≥60 岁（HR=6.41，95%CI 1.38-29.67，p=0.017）、肿瘤直径≥2cm（HR=26.54，95%CI 4.46-157.62，p<0.001）、淋巴结比率>0.5（HR=7.18，95%CI 1.74-29.74，p=0.007）和多发病灶（HR=6.98，95%CI 1.66-29.39，p=0.008）是独立的负预后因素，与节段性小肠切除术相比，右半结肠切除术（HR=0.04，95%CI 0.01-0.24，p<0.001）是独立的复发保护因素。
年龄≥60 岁、肿瘤直径≥2cm、淋巴结比率>0.5 和多发病灶的局部区域 SI-NEN 患者复发风险增加，可能受益于辅助治疗。相比之下，右半结肠切除术似乎降低了回肠 SI-NEN 的复发风险。
