Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Department of Gastroenterology, The Third Hospital of Xiamen, Xiamen, China.
Surg Endosc. 2024 Sep;38(9):5178-5186. doi: 10.1007/s00464-024-11088-z. Epub 2024 Jul 23.
The incidence of rectal neuroendocrine tumors (R-NETs) has increased in recent years. However, the predictors of lymph node (LN) metastasis and clinical outcomes, particularly following endoscopic treatment, remain unclear. Our study aims to elucidate the potential risk factors for LN metastasis and the clinical outcomes of patients undergoing endoscopic resection in R-NETs.
A total of 128 patients with R-NETs were retrospectively identified from a single center between June 2012 and December 2021. Risk factors for LN metastasis in R-NETs were analyzed using multivariate analysis. Additionally, the clinical outcomes of endoscopic resections in patients with R-NETs were assessed.
In our study, 128 patients with R-NETs were retrospectively analyzed. The risk factors for LN metastasis determined by multivariate analysis were tumor size and patient age at diagnosis. Among the 111 patients treated with endoscopic resection and with tumor margin records available, 92 underwent endoscopic submucosal dissection (ESD) and 19 underwent conventional endoscopic mucosal resection (EMR). There was no significant difference between the two groups regarding the positive rates of basal tumor margin and lateral tumor margin. Furthermore, 64 patients who underwent endoscopic resection for R-NETs were successfully followed up (range, 1.64-76.71 months), during which only one patient developed local recurrence.
Tumor size and age at diagnosis were predictors for LN metastasis of R-NETs. Both ESD and EMR are alternative techniques with a favorable prognosis for R-NETs, even in cases with positive resection margins. However, due to the relatively small number of patients undergoing EMR and missing data in follow-up protocols, definitive conclusions require further large-scale studies.
近年来直肠神经内分泌肿瘤（R-NET）的发病率有所增加。然而，淋巴结（LN）转移的预测因素以及临床结局，特别是内镜治疗后的结局仍不清楚。本研究旨在阐明 R-NET 患者 LN 转移的潜在危险因素以及内镜治疗的临床结局。
我们回顾性分析了 2012 年 6 月至 2021 年 12 月期间单一中心的 128 例 R-NET 患者。使用多变量分析来分析 R-NET 中 LN 转移的危险因素。此外，评估了 R-NET 患者内镜治疗的临床结局。
在我们的研究中，回顾性分析了 128 例 R-NET 患者。多变量分析确定的 LN 转移危险因素是肿瘤大小和诊断时患者年龄。在 111 例接受内镜切除且肿瘤边缘记录可用的患者中，92 例接受内镜黏膜下剥离术（ESD），19 例接受常规内镜黏膜切除术（EMR）。两组基底肿瘤边缘和侧向肿瘤边缘的阳性率无显著差异。此外，64 例接受内镜治疗的 R-NET 患者成功随访（范围 1.64-76.71 个月），其中仅 1 例患者发生局部复发。
肿瘤大小和诊断时的年龄是 R-NET 发生 LN 转移的预测因素。ESD 和 EMR 均是替代技术，对于 R-NET 具有良好的预后，即使在切除边缘阳性的情况下也是如此。然而，由于接受 EMR 的患者数量相对较少且随访方案中存在缺失数据，因此需要进一步的大规模研究来得出明确结论。
