Predictors of Metastases in Rectal Neuroendocrine Tumors: Results of a National Cohort Study

Concors, Seth J.; Sinnamon, Andrew J.; Folkert, Ian W.; Mahmoud, Najjia N.; Fraker, Douglas L.; Paulson, Emily Carter; Roses, Robert E.

doi:10.1097/dcr.0000000000001243

Cited by 30 publications

(27 citation statements)

References 22 publications

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“…For rectal neuroendocrine tumors, resection is routinely recommended for all tumors, but the type of resection depends predominantly on tumor size given its previously established concordance with lymph node status which has historically been shown to predict worse tumor biology. [1][2][3][4][5] Consequently, successful staging and selection for type of resection for rectal neuroendocrine tumors relies on preoperative identification of lymph node involvement. However, accurate preoperative evaluation of lymph node status remains difficult in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

A novel preoperative risk score to predict lymph node positivity for rectal neuroendocrine tumors: An NCDB analysis to guide operative technique

Gamboa

Liu

Lee

et al. 2019

Journal of Surgical Oncology

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Background/Objective Staging and type of resection for rectal neuroendocrine tumors (R‐NETS) relies on preoperative identification of lymph node (LN) involvement. Study objective was to develop a Preoperative Rectal Stratification Score (PReSS) for LN‐positivity and to assess the association of PReSS with overall survival (OS). Methods All patients in the National Cancer Database (2004‐2014) with non‐metastatic/nonfunctional R‐NETS were included. Tumor size was divided into three categories (<1, 1‐2, and ≥2 cm). Results Among 383 patients, median age was 57 years, 52% were male (n = 200), median tumor size was 1.4 cm, 43% had positive LNs (n = 163). On univariate analysis, age > 60, poorly differentiated grade, depth of invasion past submucosa, and size >1 cm were associated with LN positivity. On multivariable analysis, depth of invasion past submucosa, and increasing tumor size >1 cm remained associated with LN positivity. As these can be determined preoperatively, incidence of LN positivity was determined for each combination of tumor size and depth of invasion. Each variable was assigned a score to create a PReSS of four groups (0‐3) associated with an increasing rate of LN‐positivity (PReSS group 0: 11%, 1: 38%, 2: 50%, 3: 78%, P < .01). PReSS correlated with 10‐year OS (PReSS 0: 90%; 1: 81%; 2: 59%; 3: 41%). Conclusion For R‐NETS, depth of invasion and tumor size predict LN positivity and both can be obtained preoperatively. PReSS incorporates both variables and stratifies tumors into four risk groups of progressively increasing LN positivity and should be used to guide surgical approach.

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Section: Introductionmentioning

confidence: 99%

A novel preoperative risk score to predict lymph node positivity for rectal neuroendocrine tumors: An NCDB analysis to guide operative technique

Gamboa

Liu

Lee

et al. 2019

Journal of Surgical Oncology

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“…Some studies have advocated for RR for any tumour >10 mm due to the increased risk for lymph node (LN) and distant organ metastasis. [10][11][12][13] However, in our matched comparison of patients with tumours 10-20 mm, we found no difference in OS between LE and RR. Most guidelines recommend RR (e.g.…”

Section: Discussionmentioning

confidence: 60%

“…3,[5][6][7] Using tumour size as a criterion, some studies have suggested that local excision (LE) is sufficient for patients with tumours <2 cm, 8,9 while others recommend radical resection (RR) for all tumours >1 cm. [10][11][12][13] In addition, in a nationwide analysis of patients with rNET, 11.7% of patients underwent biopsy alone, leading the authors to suggest that observation alone is sufficient for tumours <1 cm 4 . Based on previous studies, national guidelines for the treatment of rNET are also largely stratified by tumour size, with LE recommended for tumours <2 cm and RR (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Because rNETs are relatively rare, the majority of studies on the treatment of rNETs have relied on small case series and single‐institution experiences 3,5–7 . Using tumour size as a criterion, some studies have suggested that local excision (LE) is sufficient for patients with tumours <2 cm, 8,9 while others recommend radical resection (RR) for all tumours >1 cm 10–13 . In addition, in a nationwide analysis of patients with rNET, 11.7% of patients underwent biopsy alone, leading the authors to suggest that observation alone is sufficient for tumours <1 cm 4 .…”

Section: Introductionmentioning

confidence: 99%

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Local excision versus radical resection in patients with rectal neuroendocrine tumours: a propensity score match analysis

Zhao

Hollandsworth

Lopez

et al. 2020

ANZ Journal of Surgery

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Background: The rectum is a common site for neuroendocrine tumours of the gastrointestinal tract. Diagnosis of these tumours has been increasing in recent years, highlighting the need to better define treatment options for patients with rectal neuroendocrine tumours (rNETs). Methods: We performed a retrospective analysis using the National Cancer Database (2004-2014) to compare overall survival (OS) between local excision (LE) and radical resection (RR). To minimize bias, we performed three propensity score-matched comparisons stratified by tumour size: <10 mm, 10-20 mm, >20 mm. We compared OS by Kaplan-Meier analysis. We also examined margin status and postoperative outcomes for each comparison. Results: A total of 12 996 patients underwent surgical treatment for rNET. There was no significant difference in probability of 10-year OS between LE and RR for patients with tumours <10 mm (88.6% versus 83.8%, P = 0.631, respectively) and tumours 10-20 mm (69.5% versus 69.3%, P = 0.226, respectively). In patients with tumours >20 mm, probability of 10-year OS was significantly longer in the LE group (76.5% versus 37.0%, P < 0.001). For all tumour sizes <10 mm and >20 mm, RR had significantly higher rates of 30-day readmission and negative margins. In subset analysis, there was no difference in OS for patients with positive margins after LE versus negative margins after RR for all tumour size groups. Conclusions: Our findings suggest that LE is a reasonable treatment option in patients with rNETs, especially for patients with high perioperative risk. Limitations to this study include its retrospective nature and inability to analyse surgeon decision-making.

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“…Based on the above, we can infer that that controversy regarding endoscopic or surgical resection focuses on the tumor size and lymph node metastases rather than critical factors associated with recurrence . In our study, we performed multivariate analyses to identify the different risk factors contributing to lymph node and distant metastases.…”

Section: Discussionmentioning

confidence: 96%

Rectal NETs and rectosigmoid junction NETs may need to be treated differently

Cui

et al. 2019

Cancer Medicine

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Neuroendocrine tumors (NETs) are heterogeneous, and the incidence of NETs is rapidly increasing. We observed different survival in patients with rectal NETs and rectosigmoid junction NETs, which are treated similarly. We included patients with rectal and rectosigmoid junction NETs from the SEER database. The 5‐year survival was set as the end‐point. 6675 patients with rectal NETs and 329 patients with rectosigmoid junction NETs, were eligible for the analysis. Initially, the survival analyses suggested that the 5‐year survival significantly differed between the patients with rectal and rectosigmoid junction NETs (HR = 0.82, 95% CI 0.70‐0.95; P = .01). Tumor differentiation, an invasion deeper than T2, and lymph node and distant metastases were still important risk factors affecting survival for both location. While, the males showed better survival (HR = 0.69, 95% CI 0.55‐0.88; P < .01) and primary tumor surgery had no benefits (P = .56) for patients with rectosigmoid junction NETs. The factors that predict regional lymph node metastases varied by location. In rectal NETs, invasion deeper than T1 and a tumor larger than 1 cm could significantly increase the risk of regional lymph node metastases (all OR > 5, P < .01). In rectosigmoid junction NETs, the risk of regional lymph node metastases was considered significantly higher with invasion deeper than T1 (all OR > 5, P < .01) and a tumor larger than 2 cm (OR = 31.32, 95% CI 2.53‐387.57; P < .01). We advocate a clear and consistent definition of the rectosigmoid junction for future studies, and more studies are needed to determine the reason underlying differences between rectum and rectosigmoid junction.

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Predictors of Metastases in Rectal Neuroendocrine Tumors: Results of a National Cohort Study

Cited by 30 publications

References 22 publications

A novel preoperative risk score to predict lymph node positivity for rectal neuroendocrine tumors: An NCDB analysis to guide operative technique

A novel preoperative risk score to predict lymph node positivity for rectal neuroendocrine tumors: An NCDB analysis to guide operative technique

Local excision versus radical resection in patients with rectal neuroendocrine tumours: a propensity score match analysis

Rectal NETs and rectosigmoid junction NETs may need to be treated differently

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