Troester Alexander, Weaver Lauren, Frebault Julia, Mott Sarah L, Welton Lindsay, Allievi Niccolo, Hassan Imran, Gaertner Wolfgang, Goffredo Paolo
Department of Surgery, University of Minnesota, Minneapolis, MN. Electronic address: https://twitter.com/AlexTroesterMD.
Department of Surgery, University of Minnesota, Minneapolis, MN. Electronic address: https://twitter.com/LWeaver_MD.
Surgery. 2025 Apr;180:109039. doi: 10.1016/j.surg.2024.109039. Epub 2025 Jan 4.
National Comprehensive Cancer Network guidelines recommend segmental colectomy for appendiceal neuroendocrine neoplasms >2.0 cm given the risk for lymph node involvement. However, additional clinicopathologic factors are associated with nodal metastases, and thus survival. Given dynamic changes of prognosis over time, conditional overall survival, the probability of surviving after a specific interval, has emerged as a novel oncologic outcome, but is scarcely available for appendiceal neuroendocrine neoplasms.
Adults with stage I-III appendiceal neuroendocrine neoplasms who underwent colectomy from 2010-2017 were identified in the National Cancer Database. Tumor histologies included neuroendocrine tumor grade 1, neuroendocrine tumor grades 2 and 3, neuroendocrine carcinoma, mixed neuroendocrine non-neuroendocrine neoplasm, and goblet cell carcinoma.
Of 3,541 patients (median age 51 years, 43% male, 88% White), 16% had positive lymph nodes. Overall, 40% had neuroendocrine tumor grade 1, 4% neuroendocrine tumor grades 2 and 3, 10% neuroendocrine carcinoma, 12% mixed neuroendocrine non-neuroendocrine neoplasm, and 30% goblet cell carcinoma. Increasing depth of invasion, lymphovascular invasion, and increasing size were associated with lymph node metastases. Eighty-seven percent were alive at 2 years. Mortality after 2 years was associated with older age, mixed neuroendocrine non-neuroendocrine neoplasm and goblet cell carcinoma histology, penetration through serosa, nodal involvement, and tumor size.
In a national cohort, 1 in 6 patients had positive lymph nodes, which was associated with depth of invasion, lymphovascular invasion, and size. These findings indicate additional factors should be considered when determining the extent of surgical resection and surveillance to improve survival outcomes. Additionally, patients with penetration through serosa, and mixed neuroendocrine non-neuroendocrine neoplasm or goblet cell carcinoma histology had worse conditional overall survival, potentially reflecting more aggressive tumor biology that warrants closer follow-up.
鉴于存在淋巴结受累风险，美国国立综合癌症网络指南推荐对直径大于2.0 cm的阑尾神经内分泌肿瘤行节段性结肠切除术。然而，其他临床病理因素与淋巴结转移及生存相关。考虑到预后随时间的动态变化，条件总生存（特定时间段后的生存概率）已成为一种新的肿瘤学结局指标，但阑尾神经内分泌肿瘤的相关数据却很少。
在国家癌症数据库中识别出2010年至2017年间接受结肠切除术的I - III期阑尾神经内分泌肿瘤成人患者。肿瘤组织学类型包括1级神经内分泌肿瘤、2级和3级神经内分泌肿瘤、神经内分泌癌、混合性神经内分泌-非神经内分泌肿瘤以及杯状细胞癌。
在3541例患者中（中位年龄51岁，43%为男性，88%为白人），16%有淋巴结转移。总体而言，40%为1级神经内分泌肿瘤，4%为2级和3级神经内分泌肿瘤，10%为神经内分泌癌，12%为混合性神经内分泌-非神经内分泌肿瘤，30%为杯状细胞癌。侵袭深度增加、淋巴管浸润以及肿瘤大小增加与淋巴结转移相关。87%的患者在2年时存活。2年后的死亡率与年龄较大、混合性神经内分泌-非神经内分泌肿瘤和杯状细胞癌组织学类型、穿透浆膜、淋巴结受累以及肿瘤大小相关。
在一个全国性队列中，六分之一的患者有淋巴结转移，这与侵袭深度、淋巴管浸润和肿瘤大小相关。这些发现表明，在确定手术切除范围和监测以改善生存结局时应考虑其他因素。此外，穿透浆膜以及组织学类型为混合性神经内分泌-非神经内分泌肿瘤或杯状细胞癌的患者条件总生存较差，这可能反映了更具侵袭性的肿瘤生物学行为，需要更密切的随访。
