Park Byung-Soo, Cho Sung Hwan, Son Gyung Mo, Kim Hyun Sung, Kim Su Jin, Park Su Bum, Choi Cheol Woong, Kim Hyung Wook, Shin Dong Hoon
Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
Korean J Clin Oncol. 2021 Jun;17(1):37-43. doi: 10.14216/kjco.21006. Epub 2021 Jun 30.
Rectal neuroendocrine tumors (NETs) <10 mm are endoscopically resected, while those ≥20 mm are treated with radical surgical resection. The choice of treatment for 10-20 mm sized rectal NETs remains controversial. This study aimed to verify factors predicting lymph node metastasis (LNM) of 10-20 mm sized rectal NET and utilize them to decide upon the treatment strategy.
Twenty-eight patients with 10-20 mm sized rectal NETs treated at Pusan National University Yangsan Hospital from January 2009 to September 2020 were divided into LNM (+) and LNM (-) groups, and their respective data were analyzed.
Seven patients (25%) had LNM while 21 patients (75%) did not. Endorectal ultrasound findings showed tumor size was significantly larger in the LNM (+) than in the LNM (-) group (15 mm vs. 10 mm, P=0.018); however, pathologically, there was no significant difference in tumor size (13 mm vs. 11 mm, P=0.109). The mitotic count (P=0.011), Ki-67 index (P=0.008), and proportion of tumor grade 2 patients (5 cases, 71% vs. 1 case, 5%; P=0.001) were significantly higher in the LNM (+) group. In multivariate analysis, tumor grade 2 was the independent factor predicting LNM (odds ratio, 61.32; 95% confidence interval, 3.17-1,188.64; P=0.010).
Tumor grade 2 was the independent factor predicting LNM in 10-20 mm sized rectal NETs. Therefore, it could be considered as the meaningful factor in determining whether radical resection is necessary.
直径小于10mm的直肠神经内分泌肿瘤（NETs）采用内镜下切除，而直径大于等于20mm的则采用根治性手术切除。对于直径为10 - 20mm的直肠NETs，治疗方式的选择仍存在争议。本研究旨在验证预测直径为10 - 20mm直肠NETs发生淋巴结转移（LNM）的因素，并利用这些因素来决定治疗策略。
将2009年1月至2020年9月在釜山国立大学梁山医院接受治疗的28例直径为10 - 20mm的直肠NETs患者分为LNM（+）组和LNM（-）组，并对其各自的数据进行分析。
7例患者（25%）发生LNM，21例患者（75%）未发生。直肠内超声检查结果显示，LNM（+）组的肿瘤大小明显大于LNM（-）组（15mm对10mm，P = 0.018）；然而，在病理检查中，肿瘤大小无显著差异（13mm对11mm，P = 0.109）。LNM（+）组的有丝分裂计数（P = 0.011）、Ki-67指数（P = 0.008）以及2级肿瘤患者的比例（5例，71%对1例，5%；P = 0.001）均显著更高。在多因素分析中，2级肿瘤是预测LNM的独立因素（比值比，61.32；95%置信区间，3.17 - 1,188.64；P = 0.010）。
2级肿瘤是预测直径为10 - 20mm直肠NETs发生LNM的独立因素。因此，它可被视为决定是否需要进行根治性切除的重要因素。
