European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
A retrospective analysis of 44 diminutive rectal neuroendocrine neoplasms that were not suitable for local treatment.
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Wang Zhijie, Liu Qian
Аннотация
BACKGROUND: Diminutive rectal neuroendocrine neoplasms (NENs) are often treated by local excision, but the presence of regional nodes or distant metastasis is reported in an increasing number of reports.
METHODS: We retrospectively recruited 44 patients with rectal NENs below 2 cm. These patients were not suitable for local excision due to invasion of the muscularis propria, involvement of regional lymph nodes or distant metastasis. A multivariate logistic regression model was conducted to identify the risk factors for distant metastasis. Survival analysis was performed to evaluate their prognosis.
RESULTS: Among 44 patients, 11 (25 %) had NENs smaller than 1 cm, and 33 (75 %) had NENs 1-2 cm in size. Thirty-seven patients (84.1 %) had regional node metastasis, and 14 (31.8 %) presented distant metastasis. The depth of tumor invasion (odds ratio [OR] = 20.57, 95 % confidence interval [CI]: 2.17-194.95, P = 0.008) was identified as the dominant risk factor for distant metastasis. The median overall survival (OS) was 86 months in the whole cohort, and the 1-year, 3-year and 5-year OS rates were 88.5 %, 81.9 % and 73.0 %, respectively. Poor histological differentiation (hazard ratio [HR] = 11.65, 95 % CI: 2.75-49.38, P = 0.001) and metastatic disease (HR = 7.45, 95 % CI: 1.73-32.03, P = 0.007) were significantly associated with worse OS.
CONCLUSIONS: Diminutive rectal NENs are still at risk of regional and even distant metastasis. A prudent attitude should be maintained with respect to choosing local excision as size alone is not a sufficient criterion for treatment decisions.
METHODS: We retrospectively recruited 44 patients with rectal NENs below 2 cm. These patients were not suitable for local excision due to invasion of the muscularis propria, involvement of regional lymph nodes or distant metastasis. A multivariate logistic regression model was conducted to identify the risk factors for distant metastasis. Survival analysis was performed to evaluate their prognosis.
RESULTS: Among 44 patients, 11 (25 %) had NENs smaller than 1 cm, and 33 (75 %) had NENs 1-2 cm in size. Thirty-seven patients (84.1 %) had regional node metastasis, and 14 (31.8 %) presented distant metastasis. The depth of tumor invasion (odds ratio [OR] = 20.57, 95 % confidence interval [CI]: 2.17-194.95, P = 0.008) was identified as the dominant risk factor for distant metastasis. The median overall survival (OS) was 86 months in the whole cohort, and the 1-year, 3-year and 5-year OS rates were 88.5 %, 81.9 % and 73.0 %, respectively. Poor histological differentiation (hazard ratio [HR] = 11.65, 95 % CI: 2.75-49.38, P = 0.001) and metastatic disease (HR = 7.45, 95 % CI: 1.73-32.03, P = 0.007) were significantly associated with worse OS.
CONCLUSIONS: Diminutive rectal NENs are still at risk of regional and even distant metastasis. A prudent attitude should be maintained with respect to choosing local excision as size alone is not a sufficient criterion for treatment decisions.