Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Front Endocrinol (Lausanne). 2024 Mar 27;15:1378968. doi: 10.3389/fendo.2024.1378968. eCollection 2024.
Currently, the primary treatment modalities for colorectal neuroendocrine tumors (CRNET) with a diameter between 10mm and 20mm are surgical resection (SR) and endoscopic resection (ER). However, it remains unclear which surgical approach yields the greatest survival benefit for patients.
This study included data from patients diagnosed with CRNET with tumor diameters ranging from 10mm to 20mm between the years 2004 and 2019, obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized into ER and SR groups based on the respective surgical approaches. Inverse probability weighting (IPTW) was employed to mitigate selection bias. Kaplan-Meier analysis and log-rank tests were utilized to estimate overall survival (OS) and cancer-specific survival (CSS). Cox regression analysis (univariate and multivariate) was performed to evaluate potential factors influencing survival.
A total of 292 CRNET patients were included in this study (ER group: 108 individuals, SR group: 184 individuals). Prior to IPTW adjustment, Kaplan-Meier analysis and Cox proportional hazard regression analysis demonstrated that the OS and CSS of the SR group were inferior to those of the ER group. However, after IPTW adjustment, no statistically significant differences in prognosis were observed between the two groups. Subgroup analyses revealed that patients with muscular invasion, positive lymph nodes, or distant metastasis derived greater survival benefits from SR. Significant differences in OS and CSS between the two groups were also observed across different age groups.
For patients with mucosal-limited lesions and without local lymph node or distant metastasis, ER is the preferred surgical approach. However, for patients with muscular invasion or positive lymph nodes/distant metastasis, SR offers a better prognosis. The choice of surgical approach should be based on the specific clinical characteristics of patients within different subgroups.
目前，直径在 10mm 到 20mm 之间的结直肠神经内分泌肿瘤（CRNET）的主要治疗方式是手术切除（SR）和内镜下切除（ER）。然而，哪种手术方式能为患者带来最大的生存获益仍不清楚。
本研究纳入了 2004 年至 2019 年期间，SEER 数据库中诊断为 CRNET 且肿瘤直径在 10mm 到 20mm 之间的患者数据。根据手术方式将患者分为 ER 组和 SR 组。采用逆概率加权（IPTW）法减轻选择偏倚。采用 Kaplan-Meier 分析和对数秩检验估计总生存（OS）和癌症特异性生存（CSS）。采用 Cox 回归分析（单因素和多因素）评估影响生存的潜在因素。
本研究共纳入 292 例 CRNET 患者（ER 组：108 例，SR 组：184 例）。在进行 IPTW 调整之前，Kaplan-Meier 分析和 Cox 比例风险回归分析表明，SR 组的 OS 和 CSS 均劣于 ER 组。然而，在进行 IPTW 调整后，两组的预后无统计学差异。亚组分析显示，有肌肉浸润、阳性淋巴结或远处转移的患者从 SR 中获益更大。两组间 OS 和 CSS 也存在显著差异，且在不同年龄组间存在差异。
对于黏膜局限病变且无局部淋巴结或远处转移的患者，ER 是首选的手术方式。然而，对于有肌肉浸润或阳性淋巴结/远处转移的患者，SR 可提供更好的预后。手术方式的选择应基于不同亚组中患者的具体临床特征。
