直肠神经内分泌肿瘤的内镜切除：10年随访期内无疾病相关死亡病例。
Endoscopic resection of rectal neuroendocrine tumors: zero disease-related deaths during a 10-year follow-up period.
作者信息
Hayashi Yasuyo, Ogino Haruei, Minoda Yosuke, Tanaka Yoshimasa, Hata Yoshitaka, Kubokawa Masaru, Sakisaka Seiichiro, Haraguchi Kazuhiro, Fukuda Shin-Ichiro, Itaba Soichi, Yoshimura Daisuke, Takahashi Shunsuke, Tanaka Munehiro, Kubo Hiroaki, Somada Shinichi, Ihara Eikichi, Ogawa Yoshihiro
机构信息
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan.
Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan.
出版信息
BMC Gastroenterol. 2025 Mar 11;25(1):155. doi: 10.1186/s12876-025-03736-y.
BACKGROUND
Gastrointestinal neuroendocrine tumors (GI-NETs) are slow-growing tumors with the potential for malignancy that originate from neuroendocrine cells. Therefore, early diagnosis and treatment of GI-NETs are necessary to prevent metastasis. The widespread use of colonoscopy, which allows early detection of rectal neuroendocrine tumors (rNETs) that are small enough to be treated endoscopically, has resulted in an increasing rate of endoscopic resection of rNETs. However, whether the long-term prognosis of endoscopically resected rNETs is favorable has not yet been determined. This study aimed to assess whether endoscopically resected rNETs affect the long-term prognosis of patients.
METHODS
We retrospectively reviewed the medical records of 163 consecutive patients with rNETs who underwent endoscopic resection at 11 hospitals in Japan between 1999 and 2012. The primary analysis focused on 47 patients with 51 rNETs who underwent ≥ 10 years of follow-up. The secondary analysis focused on patients who underwent less than 10 years of follow-up.
RESULTS
The median follow-up period of patients included in the primary analysis was 12.3 years (range, 10-19.1 years). The median lesion size was 5 mm (range, 2-12). Three lesions were treated using conventional endoscopic mucosal resection (EMR). Twenty-nine lesions were treated using modified EMR. Nineteen lesions were treated using endoscopic submucosal dissection. The R1 resection rate and lymphovascular invasion rate were 15.7% and 25.5%, respectively. The curative resection (CR) rate and non-CR rate were 66.7% and 33.3%, respectively. Two patients with lesions treated with non-CR underwent radical surgery. None of the 47 patients experienced lesion recurrence during the 10-year follow-up period. Two patients whose lesions were treated with CR died of other diseases.
CONCLUSIONS
Death attributable to rNETs did not occur among patients who underwent at least 10 years of follow-up after endoscopic resection.
背景
胃肠道神经内分泌肿瘤（GI-NETs）是起源于神经内分泌细胞的生长缓慢且有恶变潜能的肿瘤。因此，为防止转移，对GI-NETs进行早期诊断和治疗很有必要。结肠镜检查的广泛应用使得能够早期发现小到足以在内镜下治疗的直肠神经内分泌肿瘤（rNETs），这导致rNETs的内镜切除率不断上升。然而，内镜切除的rNETs的长期预后是否良好尚未确定。本研究旨在评估内镜切除的rNETs是否影响患者的长期预后。
方法
我们回顾性分析了1999年至2012年间在日本11家医院接受内镜切除的163例连续rNETs患者的病历。主要分析集中于47例有51个rNETs且接受了≥10年随访的患者。次要分析集中于随访时间不足10年的患者。
结果
纳入主要分析的患者的中位随访期为12.3年（范围，10 - 19.1年）。病变的中位大小为5毫米（范围，2 - 12毫米）。3个病变采用传统内镜黏膜切除术（EMR）治疗。29个病变采用改良EMR治疗。19个病变采用内镜黏膜下剥离术治疗。R1切除率和脉管侵犯率分别为15.7%和25.5%。根治性切除（CR）率和非CR率分别为66.7%和33.3%。2例非CR治疗的病变患者接受了根治性手术。47例患者在10年随访期内均未出现病变复发。2例CR治疗的病变患者死于其他疾病。
结论
内镜切除后至少随访10年的患者中未发生rNETs所致死亡。
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