直肠神经内分泌肿瘤淋巴结转移的危险因素分析及内镜切除方式比较

doi:10.19401/j.cnki.1007-3639.2022.09.007

摘要/Abstract

摘要：

背景与目的： 直肠神经内分泌肿瘤（rectal neuroendocrine neoplasm,R-NEN）的发病率呈上升趋势,但其治疗仍存在争议,特别是10 ~ 20 mm之间的肿瘤。本研究通过分析R-NEN的临床病理学特征,探讨其淋巴结转移的危险因素,并比较不同内镜切除效果的差异,探索内镜治疗R-NEN的适应证及方式。方法： 回顾性分析2007年2月—2020年12月河北医科大学第四医院收治的R-NEN患者的相关临床信息,分析淋巴结转移的危险因素,比较不同内镜切除方式的安全性和有效性。结果： 共分析了190例R-NEN患者的临床病理学特征,结果显示,肿瘤大小≥12.5 mm（OR = 69.081,95% CI：11.385 ~ 419.155,P<0.001）和淋巴管血管侵犯（OR = 11.732,95% CI：1.028 ~ 84.567,P = 0.015）是淋巴结转移的独立危险因素。比较内镜下套帽辅助黏膜切除术（endoscopic mucosal resection with cap,EMR-c）和内镜下黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗114例R-NEN患者的临床资料,结果显示,EMR-c组的手术时间明显短于ESD组[（10.23±1.99）min vs （24.78±8.09）min,P<0.001]。两组的内镜整块切除率、病理学完全切除率和并发症发生率差异无统计学意义（P>0.05）。结论： 肿瘤大小≥12.5 mm和淋巴管血管侵犯是R-NEN患者淋巴结转移的独立危险因素。对于<12.5 mm且无淋巴结转移的R-NEN来说,EMR-c和ESD均是安全有效的治疗方法。

关键词: 直肠神经内分泌肿瘤, 淋巴结转移, 内镜切除

Abstract:

Background and purpose: In recent years, the incidence of rectal neuroendocrine neoplasm (R-NEN) has been on the rise. However, its treatment remains controversial, especially for tumors of 10-20 mm in diameter. In this study, the clinicopathological characteristics of R-NEN were analyzed, the risk factors for lymph node metastasis were discussed, and the effects of different endoscopic resection were compared, so as to ascertain the indications and methods of endoscopic treatment of R-NEN. Methods: Clinical data of patients with R-NEN treated in the Fourth Hospital of Hebei Medical University from February 2007 to December 2020 were collected and retrospectively analyzed. The risk factors of lymph node metastasis were analyzed, and the safety and effectiveness of different endoscopic resection methods were compared. Results: The clinicopathological features of 190 patients with R-NEN were analyzed, suggesting that tumor size ≥12.5 mm (OR = 69.081, 95% CI: 11.385-419.155, P<0.001) and lymphovascular invasion (OR = 11.732, 95% CI: 1.028-84.567, P = 0.015) were independent risk factors for lymph node metastasis. The clinical data of 114 patients with R-NEN treated with endoscopic mucosal resection with cap (EMR-c) and endoscopic submucosal dissection (ESD) respectively were compared. The results showed that the duration of operation was significantly shorter in EMR-c group than in ESD group [(10.23±1.99) min vs (24.78±8.09) min, P<0.001]. There was no significant difference in rate of endoscopic en bloc resection, pathological complete resection rate and complication rate between the two groups (P>0.05). Conclusion: Tumor size ≥12.5 mm in diameter and presence of lymphovascular invasion are independent risk factors for lymph node metastasis in patients with R-NEN. Both EMR-c and ESD are safe and effective treatments for R-NEN of <12.5 mm in diameter and without lymph node metastasis.

Key words: Rectal neuroendocrine neoplasms, Lymph node metastasis, Endoscopic resection

中图分类号:

R735.3+7

郑秀丽, 姚志原, 吴明利, 尔丽绵, 李胜棉. 直肠神经内分泌肿瘤淋巴结转移的危险因素分析及内镜切除方式比较[J]. 中国癌症杂志, 2022, 32(9): 800-806.

ZHENG Xiuli, YAO Zhiyuan, WU Mingli, ER Limian, LI Shengmian. Analysis of risk factors of lymph node metastasis and comparison of endoscopic resection methods in rectal neuroendocrine neoplasm[J]. China Oncology, 2022, 32(9): 800-806.

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参考文献 14

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Feature	Patients (n=190) n	Lymph node metastasis (n=17) n (%)	No lymph node metastasis (n=173) n (%)	P value	Feature	Patients (n=190) n	Lymph node metastasis (n=17) n (%)	No lymph node metastasis (n=173) n (%)	P value
Gender					Lymphovascular invasion
Male	107	7 (6.5)	100 (93.5)		Negative	174	6 (3.4)	168 (96.6)
Female	83	10 (12.0)	73 (88.0)	0.208	Positive	16	11 (68.8)	5 (31.2)	<0.001
Age/year					Ki-67 proliferation index
<52	90	5 (5.6)	85 (94.4)		<5%	174	9 (5.2)	165 (94.8)
≥52	100	12 (12.0)	88 (88.0)	0.135	≥5%	16	8 (50.0)	8 (50.0)	<0.001
Tumor size/mm					CgA
<12.5	167	2 (1.2.0)	165 (98.8)		Negative	152	14 (9.2)	138 (90.8)
≥12.5	23	15 (65.2)	8 (34.8)	<0.001	Positive	38	3 (7.9)	35 (92.1)	NA
Tumor location (distance from the anus)/cm					Syn
<5	76	7 (9.2)	69 (90.8)		Negative	7	1 (14.3)	6 (85.7)
≥5	114	10 (8.8)	104 (91.2)	NA	Positive	183	16 (8.7)	167 (91.3)	NA

Factor	OR	95% CI	P value
Tumor size/mm
<12.5	1	Reference
≥12.5	69.081	11.385-419.155	<0.001
Lymphovascular invasion
negative	1	Reference
positive	11.732	1.028-84.567	0.015
Ki-67 proliferation index
<5%	1	Reference
≥5%	0.905	0.132-6.199	0.919

Characteristic	EMR-c (n=60)	ESD (n=54)	P value	Characteristic	EMR-c (n=60)	ESD (n=54)	P value
Gender				Location group
Male	40 (59.7)	27 (40.3)		Upper rectum	3 (100)	0 (0)
Female	20 (42.6)	27 (57.4)	0.087	Middle rectum	38 (56.7)	29 (43.3)
Age/year				Lower rectum	19 (43.2)	25 (56.8)	0.082
<55	36 (58.1)	26 (41.9)		EUS
≥55	24 (46.2)	28 (53.8)	0.259	Mucosal layer	21 (50.0)	21 (50.0)
Lesion size/mm $\bar{x}\pm s$	6.37±1.85	6.93±2.22	0.146	Submucosa	33 (52.4)	30 (47.6)
Lesion size group/mm				Unknown	6 (66.7)	3 (33.3)	0.652
<7	22 (55.0)	18 (45.0)		Histopathological grade
≥7	38 (51.4)	36 (48.6)	0.844	NET G1	54 (52.4)	49 (47.6)
				NET G2	6 (54.5)	5 (45.5)	NA

Outcome	EMR-c (n = 60)	ESD (n = 54)	P value
Duration of procedure/min $\bar{x}\pm s$	10.23±1.99	24.78±8.09	<0.001
En bloc resection n (%)	59 (98.3%)	54 (100.0%)	NA
P-CR rate n (%)	53 (88.3%)	42 (77.8%)	0.208
Complication n (%)	2 (3.3%)	2 (3.7%)	NA
Post-procedural bleeding	2	0
Perforation	0	2

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