Grade is a Dominant Risk Factor for Metastasis in Patients with Rectal Neuroendocrine Tumors

Folkert, Ian W.; Sinnamon, Andrew J.; Concors, Seth J.; Bennett, Bonita; Fraker, Douglas L.; Mahmoud, Najjia N.; Metz, David C.; Stashek, Kristen; Roses, Robert E.

doi:10.1245/s10434-019-07848-0

Cited by 35 publications

(32 citation statements)

References 30 publications

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“…Several previous studies and guidelines stated that each of these factors mitotic count and Ki-67 index were signi cant in predicting metastasis risk and prognosis [10,13]. On the other hand, different studies also reported that the tumor grade assessed by combining these two factors was a signi cant predictor [6,11]. In the present study on 10-20 mm sized rectal NET, the grade de ned based on the two factors combined was independent predictive factor for metastasis in multivariate analysis.…”

Section: Discussionsupporting

confidence: 46%

“…Rectal NET is known to have a better prognosis than NET of the small bowel, colon, and other sites of the body [2,4,5]. In particular, a rectal NET of a size less than 10 mm is considered an indolent lesion and is typically treated with endoscopic resection [6]. However, rectal NET over the size of 20 mm have a 60-80% chance of lymph node metastasis, in which case radical resection such as low anterior resection (LAR) or abdominoperineal resection is recommended for treatment [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Factors known to date include tumor size, tumor depth, atypical endoscopic features, lymphovascular invasion, venous invasion, mitotic count, Ki-67 index, tumor grade, and muscularis layer invasion [3,[8][9][10][11]. However, due to inconsistency among guidelines and studies, there is a confusion about the determination of appropriate treatment methods using those predicting factors [1,2,[4][5][6]. Furthermore, only a limited number of studies on 10-20 mm sized rectal NET are available.…”

Section: Introductionmentioning

confidence: 99%

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Predicting the factors for metastasis and determining treatment strategy in patients with 10–20 mm sized rectal neuroendocrine tumor

Park¹,

Cho²,

Son³

et al. 2020

Preprint

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Background: Rectal neuroendocrine tumor (NET) smaller than 10 mm is typically treated with endoscopic resection. Rectal NET larger than 20 mm should be treated with radical surgical resection. However, proper treatment for 10 - 20 mm sized rectal NET is controversial. The purpose of this study was to investigate the appropriate treatment strategy for 10-20 mm sized rectal NET by verifying factors that can predict metastasis.Methods: A total of 23 patients with 10–20 mm sized NET who were treated at Pusan National University Yangsan Hospital from January 2009 to February 2020 were included. The patients were divided into metastasis group and non-metastasis group and their respective data were analyzed.Results: Six patients had metastasis (26.1%) while 17 patients had no metastasis (73.9%). Tumor size in endorectal ultrasound (EUS) was significantly larger in the metastatic group than in the non-metastatic group (p = 0.036), however pathological tumor size did not show significant difference (p = 0.087). The rate of involvement of muscularis propria was 50% in the metastatic group, which was significantly higher than that in the non-metastatic group (p = 0.040). Lymph node enlargement was observed in a single patient (16.7%) in the metastatic group for each of EUS and computed tomography (CT) imaging. Ki-67 index in the metastatic group was higher than in the non-metastatic group. The two groups also showed a significant difference in the proportion of patients with tumor grade 2 (66.7% vs. 5.9%, p = 0.008). In multivariate analysis, tumor grade was the only independent metastasis-predicting factor (p = 0.010). Conclusions: EUS should be performed to evaluate tumor size, and muscularis propria involvement along with CT imaging to check lymph node enlargement before the treatment of 10–20 mm sized rectal NET. If endoscopic resection was performed, tumor grade should be the most important factor to determine whether additional radical resection is necessary.

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Section: Discussionsupporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predicting the factors for metastasis and determining treatment strategy in patients with 10–20 mm sized rectal neuroendocrine tumor

Park¹,

Cho²,

Son³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Rectal NETs are known to have a better prognosis than NETs of the small bowel, colon, and other sites of the body [2,4,5]. In particular, a rectal NET <10 mm is considered an indolent lesion and is typically treated with endoscopic resection [6]. However, rectal NETs >20 mm have a 60-80% chance of lymph node metastasis, in which case radical resection, such as low anterior resection (LAR) or abdominoperineal resection, is recommended for treatment [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…To date, the known factors are the tumor size, tumor depth, atypical endoscopic features, lymphovascular invasion, perineural invasion, mitotic count, Ki-67 index, tumor grade, and muscularis layer invasion [3,[8][9][10][11]. However, due to inconsistency among the guidelines and studies, there is confusion regarding the determination of the appropriate treatment methods using those predicting factors [1,2,[4][5][6]. Furthermore, only a limited number of studies on 10-20-mm sized rectal NETs is available.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor 

Park¹,

Cho²,

Son³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Rectal neuroendocrine tumors (NET) <10 mm are typically treated with endoscopic resection, while those >20 mm should be treated with radical surgical resection. However, the proper treatment methodology for 10-20-mm sized rectal NETs remains controversial. The purpose of this study was to investigate the appropriate treatment strategy for 10-20-mm sized rectal NETs by verifying factors that can predict metastasis.Methods: A total of 24 patients with 10–20-mm sized NETs who were treated at Pusan National University Yangsan Hospital from January 2009 to September 2020 were included. The patients were divided into the metastasis and non-metastasis groups, and their respective data were analyzed.Results: Seven patients had metastasis (29.2%) while 17 patients had no metastasis (70.8%). The tumor size, based on the endorectal ultrasound (EUS) findings, was significantly larger in the metastatic than in the non-metastatic group (14.4 vs. 10.2 mm, p = 0.029); however, the pathological tumor size did not show significant differences (13.3 vs. 11.8 mm, p = 0.065). Lymph node enlargement was observed in a single patient (14.3%) in the metastatic group, based on EUS and computed tomography (CT) imaging findings. The mitotic count (p = 0.017) and Ki-67 index (p = 0.014) were significantly higher in the metastatic group than in the non-metastatic group. The two groups also showed a significant difference in the proportion of patients with tumor grade 2 (71.4% vs. 5.9%, p = 0.003). In multivariate analysis, the tumor grade was the only independent metastasis-predicting factor (odds ratio = 49.25; 95% confidence interval = 2.55–950.83; p = 0.010). Conclusions: Regarding the treatment of 10–20-mm sized rectal NETs, tumor grade 2 should be the most important factor to determine whether additional radical resection is necessary.

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Prediction of the World Health Organization Grade of rectal neuroendocrine tumors based on CT histogram analysis

Liang

Tan

et al. 2020

Cancer Medicine

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Objectives To investigate the diagnostic value of contrast‐enhanced computed tomography (CECT) histogram analysis in predicting the World Health Organization (WHO) grade of rectal neuroendocrine tumors (R‐NETs). Materials and Methods A total of 61 (35 G1, 12 G2, 10 G3, and 4 NECs) patients who underwent preoperative CECT and treated with surgery to be confirmed as R‐NETs were included in this study from January 2014 to May 2019. We depicted ROIs and measured the CECT texture parameters (mean, median, 10th, 25th, 75th, 90th percentiles, skewness, kurtosis, and entropy) from arterial phase (AP) and venous phase (VP) images by two radiologists. We calculated intraclass correlation coefficient (ICC) and compared the histogram parameters between low‐grade (G1) and higher grade (HG) (G2/G3/NECs) by applying appropriate statistical method. We obtained the optimal parameters to identify G1 from HG using receiver operating characteristic (ROC) curves. Results The capability of AP and VP histogram parameters for differentiating G1 from HG was similar in several histogram parameters (mean, median, 10th, 25th, 75th, and 90th percentiles) (all p < 0.001). Skewness, kurtosis, and entropy on AP images showed no significant differences between G1 and HG ( p = 0.853, 0.512, 0.557, respectively). Entropy on VP images was significantly different ( p = 0.017) between G1 and HG, however, skewness and kurtosis showed no significant differences ( p = 0.654, 0.172, respectively). ROC analysis showed a good predictive performance between G1 and HG, and the 75th (AP) generated the highest area under the curve (AUC = 0.871), followed by the 25th (AP), mean (VP), and median (VP) (AUC = 0.864). Combined the size of tumor and the 75th (AP) generated the highest AUC. Conclusions CECT histogram parameters, including arterial and venous phases, can be used as excellent indicators for predicting G1 and HG of rectal neuroendocrine tumors, and the size of the tumor is also an important independent predictor.

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Grade is a Dominant Risk Factor for Metastasis in Patients with Rectal Neuroendocrine Tumors

Cited by 35 publications

References 30 publications

Predicting the factors for metastasis and determining treatment strategy in patients with 10–20 mm sized rectal neuroendocrine tumor

Predicting the factors for metastasis and determining treatment strategy in patients with 10–20 mm sized rectal neuroendocrine tumor

Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor

Prediction of the World Health Organization Grade of rectal neuroendocrine tumors based on CT histogram analysis

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Grade is a Dominant Risk Factor for Metastasis in Patients with Rectal Neuroendocrine Tumors

Cited by 35 publications

References 30 publications

Predicting the factors for metastasis and determining treatment strategy in patients with 10–20 mm sized rectal neuroendocrine tumor

Predicting the factors for metastasis and determining treatment strategy in patients with 10–20 mm sized rectal neuroendocrine tumor

Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor&nbsp;

Prediction of the World Health Organization Grade of rectal neuroendocrine tumors based on CT histogram analysis

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Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor