Analysis of risk factors of lymph node metastasis and comparison of endoscopic resection methods in rectal neuroendocrine neoplasm

Xiuli ZHENG; Zhiyuan YAO; Mingli WU; Limian ER; Shengmian LI

doi:10.19401/j.cnki.1007-3639.2022.09.007

您当前的位置：

首页 >

文章列表页 >

Analysis of risk factors of lymph node metastasis and comparison of endoscopic resection methods in rectal neuroendocrine neoplasm

Specialists' Article | 更新时间：2025-12-31

- Analysis of risk factors of lymph node metastasis and comparison of endoscopic resection methods in rectal neuroendocrine neoplasm
- China Oncology Vol. 32, Issue 9, Pages: 800-806(2022)
- 作者机构：
  
  1. 河北医科大学第四医院内镜科,河北石家庄 050035
  2. 河北医科大学第四医院消化内科,河北石家庄 050035
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.09.007
  CLC： R735.3+7
- Received：20 June 2022，
  
  Revised：2022-09-01，
  
  Published：30 September 2022
- 稿件说明：
移动端阅览
Xiuli ZHENG, Zhiyuan YAO, Mingli WU, et al. 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.
DOI：

Xiuli ZHENG, Zhiyuan YAO, Mingli WU, et al. 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. DOI： 10.19401/j.cnki.1007-3639.2022.09.007.

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

#x02014;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

#x02265;12.5 mm（OR = 69.081

95% CI：11.385 ~ 419.155

0.001）和淋巴管血管侵犯（OR = 11.732

95% CI：1.028 ~ 84.567

= 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

#x000b1;1.99）min

（24.78

#x000b1;8.09）min

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（

0.05）。

结论：

肿瘤大小

#x02265;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。

Abstract

Background and purpose:

In recent years

the incidence of rectal neuro

endocrine 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

#x02265;12.5 mm (OR = 69.081

95% CI: 11.385-419.155

0.001) and lymphovascular invasion (OR = 11.732

95% CI: 1.028-84.567

= 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

#x000b1;1.99) min

(24.78

#x000b1;8.09) min

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 (

0.05).

Conclusion:

Tumor size

#x02265;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.

关键词

Keywords

references

FOLKERT I W , SINNAMON A J , CONCORS S J , et al . Grade is a dominant risk factor for metastasis in patients with rectal neuroendocrine tumors [J ] . Ann Surg Oncol , 2020 , 27 ( 3 ): 855 - 863 . DOI: 10.1245/s10434-019-07848-0 http://doi.org/10.1245/s10434-019-07848-0

FAN J H , ZHANG Y Q , SHI S S , et al . A nation-wide retrospective epidemiological study of gastroenteropancreatic neuroendocrine neoplasms in China [J ] . Oncotarget , 2017 , 8 ( 42 ): 71699 - 71708 . DOI: 10.18632/oncotarget.17599 http://doi.org/10.18632/oncotarget.17599 https://www.oncotarget.com/lookup/doi/10.18632/oncotarget.17599 https://www.oncotarget.com/lookup/doi/10.18632/oncotarget.17599

WOOD D E . National Comprehensive Cancer Network (NCCN) clinical practice guidelines for lung cancer screening [J ] . Thorac Surg Clin , 2015 , 25 ( 2 ): 185 - 197 . DOI: 10.1016/j.thorsurg.2014.12.003 http://doi.org/10.1016/j.thorsurg.2014.12.003

AL-SUKHNI E , MILOT L , FRUITMAN M , et al . Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis [J ] . Ann Surg Oncol , 2012 , 19 ( 7 ): 2212 - 2223 . DOI: 10.1245/s10434-011-2210-5 http://doi.org/10.1245/s10434-011-2210-5 http://link.springer.com/10.1245/s10434-011-2210-5 http://link.springer.com/10.1245/s10434-011-2210-5

NAGTEGAAL I D , ODZE R D , KLIMSTRA D , et al . The 2019 WHO classification of tumours of the digestive system [J ] . Histopathology , 2020 , 76 ( 2 ): 182 - 188 . DOI: 10.1111/his.13975 http://doi.org/10.1111/his.13975

GLEESON F C , LEVY M J , DOZOIS E J , et al . Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes [J ] . Gastrointest Endosc , 2014 , 80 ( 1 ): 144 - 151 . DOI: 10.1016/j.gie.2013.11.031 http://doi.org/10.1016/j.gie.2013.11.031

MODLIN I M , LYE K D , KIDD M . A 5-decade analysis of 13, 715 carcinoid tumors [J ] . Cancer , 2003 , 97 ( 4 ): 934 - 959 . DOI: 10.1002/cncr.11105 http://doi.org/10.1002/cncr.11105 https://onlinelibrary.wiley.com/doi/10.1002/cncr.11105 https://onlinelibrary.wiley.com/doi/10.1002/cncr.11105

DUAN X L , ZHAO M , ZHANG S L , et al . Effects of tumor distance from anal verge on survival outcomes for rectal NENs and lymphatic metastasis risk score for colorectal NENs [J ] . Int J Colorectal Dis , 2020 , 35 ( 7 ): 1255 - 1264 . DOI: 10.1007/s00384-020-03596-w http://doi.org/10.1007/s00384-020-03596-w

SHIM K N , YANG S K , MYUNG S J , et al . Atypical endoscopic features of rectal carcinoids [J ] . Endoscopy , 2004 , 36 ( 4 ): 313 - 316 .

KONISHI T , WATANABE T , KISHIMOTO J , et al . Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years [J ] . Gut , 2007 , 56 ( 6 ): 863 - 868 .

AHMED Y , OTHMAN M . EMR/ESD: techniques, complications, and evidence [J ] . Curr Gastroenterol Rep , 2020 , 22 ( 8 ): 39 . DOI: 10.1007/s11894-020-00777-z http://doi.org/10.1007/s11894-020-00777-z

DĄBKOWSKI K , RUSINIAK-ROSSIŃSKA N , MICHALSKA K , et al . Endoscopic treatment of rectal neuroendocrine tumors in a 13-year retrospective single-center study: are we following the guidelines? [J ] . Pol Arch Intern Med , 2021 , 131 ( 3 ): 241 - 248 .

YANG D H , PARK Y , PARK S H , et al . Cap-assisted EMR for rectal neuroendocrine tumors: comparisons with conventional EMR and endoscopic submucosal dissection (with videos) [J ] . Gastrointest Endosc , 2016 , 83 ( 5 ): 1015 - 1022 ;quiz1023-.e6. DOI: 10.1016/j.gie.2015.09.046 http://doi.org/10.1016/j.gie.2015.09.046 https://linkinghub.elsevier.com/retrieve/pii/S0016510715029612 https://linkinghub.elsevier.com/retrieve/pii/S0016510715029612

CHA J H , JUNG D H , KIM J H , et al . Long-term outcomes according to additional treatments after endoscopic resection for rectal small neuroendocrine tumors [J ] . Sci Rep , 2019 , 9 ( 1 ): 4911 . DOI: 10.1038/s41598-019-40668-6 http://doi.org/10.1038/s41598-019-40668-6

Views

2296

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Advances in understanding the correlation between lymph node metastasis and immune regulation in breast cancer through spatiotemporal transcriptomic analysis

A study on the correlation between plasmacytoid dendritic cells and lymph node metastasis in advanced gastric cancer

Analysis of therapeutic response of iodine positive metastasis lymph nodes in differentiated thyroid cancer after ¹³¹I treatment

Correlation analysis of neck node levels in 709 cases of nasopharyngeal carcinoma

The impact of lymph node metastasis on the clinical parameters and prognosis of intrahepatic cholangiocarcinoma patients after curative resection

Related Author

QIU Pengfei

ZHENG Luming

LING Yuanchao

BI Zhao

WANG Xiaowen

WANG Yongsheng

Zhanwei CHEN

Yaoqiang WU

Related Institution

The 960th Hospital of PLA

Shandong First Medical University (Shandong Provincial Academy of Medical Sciences)

Department of Breast Cancer Center, Shandong First Medical University Affiliated Tumor Hospital (Shandong Provincial Institute of Cancer Prevention and Treatment, Shandong Cancer Hospital)

Department of General Surgery, First Hospital of Dandong City

Department of Nuclear Medical, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine

AI问答

⁰