Son Jimin, Park In Ja, Yang Dong-Hoon, Kim Jisup, Kim Kyoung-Jo, Byeon Jeong-Sik, Hong Seung Mo, Kim Young Il, Kim Jong Beom, Lim Seok-Byung, Yu Chang Sik, Kim Jin Cheon
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Surg Endosc. 2022 Apr;36(4):2445-2455. doi: 10.1007/s00464-021-08527-6. Epub 2021 May 19.
Owing to an increased number of colonoscopy screenings, the incidence of diagnosed rectal neuroendocrine tumors (NETs) has also increased. Tumor size is one of the most frequently regarded factors when selecting treatment; however, it may not be the determinant prognostic variable. We aimed to evaluate oncological outcomes according to the treatment modality based on the size of rectal NETs.
A retrospective analysis was performed on patients who were treated for rectal NETs between March 2000 and January 2016 at the Asan Medical Center, Seoul, Korea. Patients who underwent endoscopic removal, local surgical excision, and radical resection were included. The primary outcome was recurrence-free survival (RFS). Data were specified and analyzed following the 2019 World Health Organization classification (WHO).
A total of 644 patients were categorized under three groups according to the treatment modality used: endoscopic removal (n = 567), surgical local excision (n = 56), and radical resection (n = 21). Of a total of 35 recurrences, 27 were local, whereas eight were distant. The RFS rate did not differ significantly between the treatment groups in the same tumor-size group ([Formula: see text]1 cm group: P = .636, 1-2 cm group: P = .160). For T1 tumors, RFS rate was not different between local excision and radical resection ([Formula: see text]1 cm group: P = .452, 1-2 cm group: P = .700). Depth of invasion, a high Ki-67 index, and margin involvement were confirmed as independent risk factors for recurrence. Among patients treated with endoscopic removal, endoscopic biopsy was a significant factor for worse RFS (P < .001), while tumor size did not affect the RFS.
The current guideline recommends treatment options according to tumor size. However, more oncologically important prognostic factors include muscularis propria invasion and a higher Ki-67 index.
由于结肠镜检查筛查数量的增加，已诊断的直肠神经内分泌肿瘤（NETs）的发病率也有所上升。肿瘤大小是选择治疗方法时最常考虑的因素之一；然而，它可能不是决定性的预后变量。我们旨在根据直肠NETs的大小，评估基于治疗方式的肿瘤学结局。
对2000年3月至2016年1月在韩国首尔峨山医学中心接受直肠NETs治疗的患者进行回顾性分析。纳入接受内镜切除、局部手术切除和根治性切除的患者。主要结局是无复发生存期（RFS）。数据按照2019年世界卫生组织分类（WHO）进行指定和分析。
根据所采用的治疗方式，共有644例患者分为三组：内镜切除（n = 567）、手术局部切除（n = 56）和根治性切除（n = 21）。在总共35例复发中，27例为局部复发，8例为远处复发。在相同肿瘤大小组的治疗组之间，RFS率无显著差异（＜1 cm组：P = 0.636，1 - 2 cm组：P = 0.160）。对于T1肿瘤，局部切除和根治性切除之间的RFS率无差异（＜1 cm组：P = 0.452，1 - 2 cm组：P = 0.700）。浸润深度、高Ki-67指数和切缘受累被确认为复发的独立危险因素。在内镜切除治疗的患者中，内镜活检是RFS较差的一个重要因素（P＜0.001），而肿瘤大小不影响RFS。
当前指南根据肿瘤大小推荐治疗方案。然而，在肿瘤学上更重要的预后因素包括肌层浸润和更高的Ki-67指数。
