Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Internal Medicine, Myongji Hospital, Goyang, Republic of Korea.
Scand J Gastroenterol. 2024 Jul;59(7):868-874. doi: 10.1080/00365521.2024.2340008. Epub 2024 Apr 8.
While endoscopic resection of rectal neuroendocrine tumors (NETs) has significantly increased, long-term data on risk factors for recurrence are still lacking. Our aim is to analyze the long-term outcomes of patients with rectal NETs after endoscopic resection through risk stratification.
In this multicenter retrospective study, we included patients who underwent endoscopic resection of rectal NETs from 2009 to 2018 and were followed for ≥12 months at five university hospitals. We classified the patients into three risk groups according to the clinicopathological status of the rectal neuroendocrine tumors: low, indeterminate, and high. The high-risk group was defined if the tumors have any of the followings: size ≥ 10 mm, lymphovascular invasion, muscularis propria or deeper invasion, positive resection margins, or mitotic count ≥2/10.
A total of 346 patients were included, with 144 (41.6%), 121 (35.0%), and 81 (23.4%) classified into the low-, indeterminate-, and high-risk groups, respectively. Among the high-risk group, seven patients (8.6%) received salvage treatment 28 (27-67) days after the initial endoscopic resection, with no reported extracolonic recurrence. Throughout the follow-up period, 1.1% (4/346) of patients experienced extracolonic recurrences at 56.5 (54-73) months after the initial endoscopic resection. Three of these patients (75%) were in the high-risk group and did not undergo salvage treatment. The risk of extracolonic recurrence was significantly higher in the high-risk group compared to the other groups ( = 0.039).
Physicians should be concerned about the possibility of metastasis during long-term follow-up of high-risk patients and consider salvage treatment.
虽然内镜下直肠神经内分泌肿瘤（NETs）切除术显著增加，但仍缺乏关于复发危险因素的长期数据。我们旨在通过风险分层分析内镜下切除直肠 NET 患者的长期预后。
在这项多中心回顾性研究中，我们纳入了 2009 年至 2018 年在五所大学医院接受内镜下直肠 NET 切除术且随访时间≥12 个月的患者。我们根据直肠神经内分泌肿瘤的临床病理状况将患者分为三个风险组：低危、中危和高危。高危组定义为肿瘤具有以下任何一种特征：大小≥10mm、脉管侵犯、固有肌层或更深层侵犯、切缘阳性或有丝分裂计数≥2/10。
共纳入 346 例患者，其中低危组 144 例（41.6%），中危组 121 例（35.0%），高危组 81 例（23.4%）。在高危组中，有 7 例（8.6%）患者在初次内镜切除后 28（27-67）天接受了挽救治疗，无结外复发报道。在整个随访期间，有 4 例（1.1%）患者在初次内镜切除后 56.5（54-73）个月发生结外复发。这 3 例患者（75%）均处于高危组且未接受挽救治疗。与其他组相比，高危组结外复发的风险显著更高（=0.039）。
对于高危患者，医生应在长期随访中关注转移的可能性，并考虑进行挽救治疗。
