Ogata Yohei, Hatta Waku, Kanno Takeshi, Hatayama Yutaka, Saito Masahiro, Jin Xiaoyi, Koike Tomoyuki, Imatani Akira, Yuan Yuhong, Masamune Atsushi
Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Department of Medicine, London Health Science Centre, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
J Gastroenterol. 2025 Jun;60(6):673-682. doi: 10.1007/s00535-025-02247-7. Epub 2025 Apr 3.
Although the status of lymph node metastasis (LNM) is crucial in determining treatment strategy for duodenal neuroendocrine tumors (D-NETs), robust evidence for their potential LNM risk remains lacking. This systematic review aimed to summarize the prevalence and risk factors of LNM in D-NETs.
This systematic review of electronic databases identified eligible case-control and cohort studies for D-NET resected either endoscopically or surgically, published from 1990 to 2023. The primary outcome was the pooled prevalence of LNM in D-NETs. Secondary outcomes included the pooled prevalence of LNM according to tumor location and functionality, as well as identifying pathological risk factors for LNM. Meta-analysis was performed.
We identified 36 studies that involved 1,396 patients with D-NETs, including 326 with LNM. The pooled prevalence of LNM in D-NETs was 22.7% (95% confidence interval [CI] 17.3-29.2%). The prevalence was high in ampullary/peri-ampullary D-NETs and functional D-NETs (46.8 and 53.3%, respectively), whereas it was low in non-functional, non-ampullary D-NETs (NAD-NETs) (9.5%). Pathological risk factors for LNM in NAD-NETs included tumor size > 10 mm (odds ratio [OR] 7.31 [95% CI 3.28-16.31]), tumor invasion into the muscularis propria or deeper (OR 7.79 [3.65-16.61]), lymphovascular invasion (OR 5.67 [2.29-14.06]), and World Health Organization grading of G2 (OR 2.47 [1.03-5.92]).
Approximately one-fourth of the patients with D-NETs had LNM. Endoscopic resection might be acceptable for non-functional NAD-NETs with diameters of 10 mm or less, but additional surgical resection with lymphadenectomy may be recommended for cases exhibiting pathological risk factors.
尽管淋巴结转移（LNM）状态对于确定十二指肠神经内分泌肿瘤（D-NETs）的治疗策略至关重要，但关于其潜在LNM风险的有力证据仍然缺乏。本系统评价旨在总结D-NETs中LNM的患病率及危险因素。
本对电子数据库的系统评价确定了1990年至2023年发表的符合条件的病例对照研究和队列研究，这些研究涉及经内镜或手术切除的D-NETs。主要结局是D-NETs中LNM的合并患病率。次要结局包括根据肿瘤位置和功能的LNM合并患病率，以及确定LNM的病理危险因素。进行了荟萃分析。
我们确定了36项研究，涉及1396例D-NETs患者，其中326例有LNM。D-NETs中LNM的合并患病率为22.7%（95%置信区间[CI]17.3-29.2%）。壶腹/壶腹周围D-NETs和功能性D-NETs的患病率较高（分别为46.8%和53.3%），而非功能性、非壶腹D-NETs（NAD-NETs）的患病率较低（9.5%）。NAD-NETs中LNM的病理危险因素包括肿瘤大小>10mm（优势比[OR]7.31[95%CI 3.28-16.31]）、肿瘤侵犯固有肌层或更深层（OR 7.79[3.65-16.61]）、淋巴管侵犯（OR 5.67[2.29-14.06]）以及世界卫生组织G2分级（OR 2.47[1.03-5.92]）。
约四分之一的D-NETs患者有LNM。对于直径10mm或更小的非功能性NAD-NETs，内镜切除可能是可接受的，但对于存在病理危险因素的病例，可能建议进行额外的手术切除并清扫淋巴结。
