Wu X, Peng C, Lin M, Li Z, Yang X, Liu J, Yang X, Zuo X
Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
J Endocrinol Invest. 2024 Mar;47(3):671-681. doi: 10.1007/s40618-023-02185-2. Epub 2023 Aug 31.
The efficacy and safety of local excision (LE) for small (< 1‒2 cm) colonic neuroendocrine tumors (NETs) is controversial due to the higher metastasis risk when compared with rectal NETs. The study aimed to evaluate the metastasis risk of T1 colonic NETs and compare patients' long-term prognosis after LE or radical surgery (RS).
The Surveillance Epidemiology and End Results database was used to identify patients with T1 colonic NETs (2004‒2015). Multivariable logistic regression was performed to assess factors associated with metastasis risk. Propensity score matching was used to balance the variables. Cancer-specific survival (CSS) and overall survival (OS) were calculated to estimate the prognosis of patients with T1N0M0 colonic NETs who underwent LE or RS.
Of the 610 patients with colonic NETs, 46 (7.54%) had metastasis at diagnosis. Tumor size (11-20 mm) (OR = 9.51; 95% confidence interval (CI): 4.32‒21.45; P < 0.001), right colon (OR = 15.79; 95% CI 7.20‒38.56; P < 0.001), submucosal infiltration (OR = 2.08; 95% CI 0.84‒5.57; P = 0.125) were independent risk factors associated with metastasis. Of the 515 patients with T1N0M0 colonic NETs, the overall long-term prognosis of LE was as good as that of RS groups (after matching, 5-year CSS: 97.9% vs. 94.6%, P = 0.450; 5-year OS: 92.7% vs. 85.6%, P = 0.009).
Tumor size (11‒20 mm) and site (right colon) are associated with metastasis in T1 colonic NETs. In the absence of metastasis, LE could be a viable option for 0‒10 mm T1 colonic NETs with well/moderate differentiation in the left colon in terms of long-term survival.
与直肠神经内分泌肿瘤相比，小（<1‒2 cm）结肠神经内分泌肿瘤（NETs）局部切除（LE）的疗效和安全性存在争议，因为其转移风险更高。本研究旨在评估T1期结肠NETs的转移风险，并比较LE或根治性手术（RS）后患者的长期预后。
利用监测、流行病学和最终结果数据库识别T1期结肠NETs患者（2004‒2015年）。进行多变量逻辑回归以评估与转移风险相关的因素。采用倾向评分匹配法平衡变量。计算癌症特异性生存率（CSS）和总生存率（OS），以评估接受LE或RS的T1N0M0期结肠NETs患者的预后。
在610例结肠NETs患者中，46例（7.54%）在诊断时已有转移。肿瘤大小（11 - 20 mm）（比值比[OR]=9.51；95%置信区间[CI]：4.32‒21.45；P<0.001）、右半结肠（OR = 15.79；95%CI 7.20‒38.56；P<0.001）、黏膜下浸润（OR = 2.08；95%CI 0.84‒5.57；P = 0.125）是与转移相关的独立危险因素。在515例T1N0M0期结肠NETs患者中，LE组与RS组的总体长期预后相当（匹配后，5年CSS：97.9%对94.6%，P = 0.450；5年OS：92.7%对85.6%，P = 0.009）。
肿瘤大小（11‒20 mm）和部位（右半结肠）与T1期结肠NETs的转移相关。在无转移的情况下，就长期生存而言，LE可能是左半结肠0‒10 mm、高/中分化T1期结肠NETs的一种可行选择。
