Du Rui, Xiao Jiang-Wei
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China.
World J Clin Cases. 2022 Oct 26;10(30):10906-10920. doi: 10.12998/wjcc.v10.i30.10906.
The prognosis of patients with appendiceal neuroendocrine tumors (ANETs) is related to lymph node (LN) metastasis and other factors. However, it is unclear how the number of examined LNs (ELNs) impact on survival.
To determine the factors affecting the cancer-specific survival (CSS) of patients with ANET and to evaluate the impact of the number of ELNs on survival.
A total of 4583 ANET patients were analyzed in the Surveillance, Epidemiology, and End Results database. Univariate survival analysis was used to identify factors related to survival and the optimal number of ELNs and lymph node ratio (LNR) were determined by the Kaplan-Meier method. The survival difference was determined by CSS.
Except for sex, the other factors, such as age, year, race, grade, histological type, stage, tumor size, ELNs, LNR, and surgery type, were associated with prognosis. The 3-, 5-, and 10-year CSS rates of ANET patients were 91.2%, 87.5, and 81.7%, respectively (median follow-up period of 31 mo and range of 0-499 mo). There was no survival difference between the two surgery types, namely, local resection and colectomy or greater, in both stratifications of tumor size ≥ 2 cm ( = 0.523) and < 2 cm ( = 0.068). In contrast to patients with a tumor size < 2 cm, those with a tumor size ≥ 2 cm were more likely to have LN metastasis ( = 378.16, < 0.001). The optimal number of ELNs was more than 11, 7, and 18 for all patients, node-negative patients, and node-positive patients, respectively. CSS rates of patients with a larger number of ELNs were significantly improved (≤ 10 ≥ 11, = 20.303, < 0.001; ≤ 6 ≥ 7, = 11.569, < 0.001; ≤ 17 ≥ 18, = 21.990, < 0.001; respectively). ANET patients with an LNR value ≤ 0.16 were more likely to have better survival than those with values of 0.17-0.48 ( = 48.243, < 0.001) and 0.49-1 ( = 168.485, < 0.001).
ANET ≥ 2 cm are more likely to develop LN metastasis. At least 11 ELNs are required to better evaluate the prognosis. For patients with positive LN metastasis, 18 or more LNs need to be detected and lower LNR values (LNR ≤ 0.16) indicate a better survival prognosis.
阑尾神经内分泌肿瘤（ANETs）患者的预后与淋巴结（LN）转移及其他因素有关。然而，检查的淋巴结数量（ELNs）如何影响生存尚不清楚。
确定影响ANET患者癌症特异性生存（CSS）的因素，并评估ELNs数量对生存的影响。
在监测、流行病学和最终结果数据库中分析了4583例ANET患者。采用单因素生存分析确定与生存相关的因素，并通过Kaplan-Meier法确定ELNs的最佳数量和淋巴结比率（LNR）。通过CSS确定生存差异。
除性别外，年龄、年份、种族、分级、组织学类型、分期、肿瘤大小、ELNs、LNR和手术类型等其他因素均与预后相关。ANET患者的3年、5年和10年CSS率分别为91.2%、87.5%和81.7%（中位随访期31个月，范围0 - 499个月）。在肿瘤大小≥2 cm（P = 0.523）和<2 cm（P = 0.068）的两个分层中，局部切除和结肠切除术或更大范围手术这两种手术类型之间均无生存差异。与肿瘤大小<2 cm的患者相比，肿瘤大小≥2 cm的患者更易发生LN转移（P = 378.16，P < 0.001）。所有患者、淋巴结阴性患者和淋巴结阳性患者的ELNs最佳数量分别为超过11个、7个和18个。ELNs数量较多的患者CSS率显著提高（≤10 vs ≥11，P = 20.303，P < 0.001；≤6 vs ≥7，P = 11.569，P < 0.001；≤17 vs ≥18，P = 21.990，P < 0.001）。LNR值≤0.16的ANET患者比LNR值为0.17 - 0.48（P = 48.243，P < 0.001）和0.49 - 1（P = 168.485，P < 0.001）的患者更有可能具有更好的生存。
肿瘤大小≥2 cm的ANET更易发生LN转移。至少需要11个ELNs才能更好地评估预后。对于LN转移阳性的患者，需要检测18个或更多的LN，较低的LNR值（LNR≤0.16）表明生存预后较好。
