Butz Frederike, Müller-Debus Charlotte Friederike, Ecseri Flora Georgina, Mani Gianna Sophia, Akgündüz Elif, Dukaczewska Agata, Steinhagen Peter Richard, Fehrenbach Uli, Kunze Catarina A, Jann Henning, Pratschke Johann, Dobrindt Eva Maria, Mogl Martina T
Department of Surgery, Campus Charité Mitte | Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany.
Department of Hepatology and Gastroenterology, Campus Charité Mitte | Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany.
Cancers (Basel). 2025 Aug 29;17(17):2841. doi: 10.3390/cancers17172841.
BACKGROUND/OBJECTIVES: Neuroendocrine neoplasms (NENs) of the rectum (rNEN) are a rare and heterogeneous group of tumors that can vary greatly in their biological behavior, from benign to highly aggressive. While small and well-differentiated tumors can often be handled endoscopically and still face a very good prognosis, tumor size, and grade, as well as lymph node and distant metastasis, are known risk factors for impaired prognosis. This study aimed at the identification of further prognostic factors in rNEN.
A retrospective analysis of patients treated for rNEN at the ENTES Center of Excellence at Charité-Universitätsmedizin, including n = 121 patients, was performed to identify risk factors for recurrence, progression, and impaired outcome.
Progression-free survival (PFS) and overall survival (OS) differed significantly according to tumor grade ( < 0.001). In rNET patients undergoing surgery, the Ki-67 index and distant metastases were independent risk factors for shorter PFS. Among stage I rNETs, 10 patients developed disease recurrence, associated with lymphatic invasion (1.9% vs. 30.0%, = 0.008) and higher Ki-67 values (2 (1-6) vs. 2 (1-16), = 0.054).
Tumor grade and presence of metastases represent important predictive factors in rNEN. Notably, even small, early-stage rNETs can harbor a risk of recurrence when unfavorable pathological features are present, highlighting the importance of tailored, risk-adapted surveillance strategies to optimize patient outcomes.
背景/目的：直肠神经内分泌肿瘤（rNEN）是一组罕见且异质性的肿瘤，其生物学行为差异很大，从良性到高度侵袭性。虽然小的、高分化的肿瘤通常可以通过内镜处理，且预后良好，但肿瘤大小、分级以及淋巴结和远处转移是已知的预后不良风险因素。本研究旨在确定rNEN的其他预后因素。
对在柏林夏里特大学医学中心卓越ENTES中心接受rNEN治疗的患者进行回顾性分析，共纳入121例患者，以确定复发、进展和预后不良的风险因素。
无进展生存期（PFS）和总生存期（OS）根据肿瘤分级有显著差异（<0.001）。在接受手术的rNET患者中，Ki-67指数和远处转移是PFS较短的独立风险因素。在I期rNET患者中，10例出现疾病复发，与淋巴浸润（1.9%对30.0%，=0.008）和较高的Ki-67值（2（1-6）对2（1-16），=0.054）相关。
肿瘤分级和转移的存在是rNEN的重要预测因素。值得注意的是，即使是小的、早期的rNETs，当存在不利的病理特征时也可能有复发风险，这突出了制定个性化、风险适应性监测策略以优化患者预后的重要性。
