Patterns of Lymph Node Metastasis in Patients With T1/T2 Gastroduodenal Neuroendocrine Neoplasms: Implications for Endoscopic Treatment

Abstract

Guidelines have differed in their opinion regarding the indications for endoscopic resection of gastric-neuroendocrine neoplasms (g-NENs) and duodenal-NENs (d-NENs). We examined the association between size and lymph node metastasis (LNM) to identify candidates most suitable for endoscopic resection. We identified 706 patients with T1/T2 g-NENs and 621 patients with T1/T2 d-NENs from the SEER database. The prevalence of LNM and risk factors associated with LNM were analyzed. LNM was present in 8.1% of patients with gastroduodenal neuroendocrine tumors (NETs) and 31.6% of patients with neuroendocrine carcinomas (NECs). Multivariate logistic regression indicated that tumor size >10mm, greater invasion depth, and poor differentiation were independently associated with LNM. In addition, the percentage of g-NETs invading submucosa with LNM increased with tumor size (≤10 mm,3.9%;11–20 mm,8.6%;>20 mm,16.1%). However, in contrast to the low LNM risk in patients with small g-NETs (≤10 mm), we found that LNM rate exceeded 5% even for patients with small submucosal-infiltrating d-NETs. Among patients with nodal-negative g-NETs, the cause specific survival (CSS) was similar for those who received surgical resection and endoscopic resection. Among patients with d-NETs, the CSS was better for those who received endoscopic resection. In conclusion, patients with d-NETs had a higher probability of LNM than those with g-NETs. Endoscopic resection can be utilized for curative treatment of submucosa-infiltrating g-NETs and intramucosal d-NETs when the size is 10 mm or less. These results reinforce the need to search for LNM in lesions that are larger than 10 mm.

Risk factors, prognostic factors, and nomograms for distant metastasis in patients with diagnosed duodenal cancer: A population-based study

“…In our study, we observed a positive correlation between higher T stage and the incidence of DM, as well as a positive correlation between higher N stage and the incidence of DM. These findings are consistent with previous research, indicating that cellular migration, invasion, and lymph node metastasis are crucial factors contributing to tumor progression and metastasis[ 23 - 25 ]. The correlation between tumor size and the occurrence of metastasis is undeniable, and our study confirms this relationship[ 26 , 27 ].…”

Patterns of Lymph Node Metastasis and Optimal Surgical Strategy in Small (≤20 mm) Gastroenteropancreatic Neuroendocrine Tumors

“…Herein, the LNM rate was 4.1% for g-NETs ≤ 10 mm. However, for tumors of 11–20 mm, there was a remarkable increase in the LNM rate, which reached 12.1%, with previous studies reporting a range of 8.6 to 15.3% ( 6 , 20 , 21 ). Consistent with a recent study ( 22 ), we found that LNM was slightly associated with unfavorable OS in small g-NETs (HR, 2.48; p = 0.061) and regional lymphadenectomy had survival advantages for g-NETs 11–20 mm (HR, 0.39; 95% CI, 0.16–0.96; p = 0.041).…”

“…The inconclusive guidelines with regard to the surgical procedures are due to the ambiguity of nodal metastasis risk at different anatomical subsites. A limited number of studies have evaluated on the regional lymph node metastasis (LNM) patterns in small GEP-NETs with most of them assessing a single site of origin (6)(7)(8)(9)(10)(11)(12). Moreover, the impact of regional nodal involvement on prognosis in small GEP-NETs has not been conclusively determined.…”