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Risk Factor Analysis of Lymph Node Metastasis for Rectal Neuroendocrine Tumors: Who Needs a Radical Resection in Rectal Neuroendocrine Tumors Sized 1–2 cm?

  • Colorectal Cancer
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Rectal neuroendocrine tumors (NETs) have malignant potential, and lymph node (LN) or distant metastases can occur; however, treatment of NETs 1–2 cm in size is controversial.

Objective

This study aimed to identify predictive factors for LN metastasis and prognostic factors for recurrence of rectal NETs, especially tumors 1‒2 cm in size.

Methods

Between October 2004 and November 2020, 453 patients underwent endoscopic or surgical treatment for rectal NETs in Seoul National University Hospital. The data on these patients were prospectively collected in our database and reviewed retrospectively. In cases of local excision, we evaluated LN metastasis with radiologic imaging, including computed tomography or magnetic resonance imaging before treatment and during the follow-up periods.

Results

LN metastasis was observed in 40 patients (8.8%). A higher rate of LN metastasis was observed in larger-sized tumors, advanced T stage, lymphovascular invasion (LVI), perineural invasion (PNI), and high tumor grade. In multivariable analysis, the significant risk factors for LN metastasis were tumor size (1 ≤ size < 2 cm: hazard ratio [HR] 64.07; size ≥2 cm: HR 102.37, p < 0.001) and tumor grade (G2: HR 3.63, p = 0.034; G3: HR 5.09, p = 0.044). In multivariable analysis for tumors 1–2 cm in size, the risk factor for LN metastasis was tumor grade (G2: HR 6.34, p = 0.013).

Conclusions

Tumor grade and size are important predictive factors for LN metastasis. In NETs 2 cm in size, tumor grade is also important for LN metastasis, and radical resection should be considered.

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Acknowledgment

The authors thank Medical Research Collaborating Center of Seoul National University Hospital for their help in the statistical analyses of this study.

Funding

This study was supported by the grant of Seoul National University Hospital (No.3020210260) donated from WOOWON construction.

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Authors and Affiliations

  1. Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea

    Jin Sun Choi MD, Rumi Shin MD, PhD & Seung Chul Heo MD, PhD

  2. Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Jin Sun Choi MD, Min Jung Kim MD, PhD, Ji Won Park MD, PhD, Seung-Yong Jeong MD, PhD, Kyu Joo Park MD, PhD & Seung-Bum Ryoo MD, PhD

  3. Department of Surgery, Cancer Research Institute, Seoul National University, Seoul, Republic of Korea

    Min Jung Kim MD, PhD, Ji Won Park MD, PhD, Seung-Yong Jeong MD, PhD, Kyu Joo Park MD, PhD & Seung-Bum Ryoo MD, PhD

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Contributions

Study conception and design: JSC, S-BR, MJK, RS, JWP, S-YJ, KJP. Data acquisition: JSC, S-BR, MJK, RS, JWP, S-YJ, KJP. Data analysis and interpretation: JSC, S-BR, SCH, S-YJ. Drafting the article: JSC, S-BR, SCH. Critical revision for important intellectual content: JSC, S-BR, SCH, KJP. Final approval of the manuscript and agree to be accountable for all aspects of the work to ensure that questions regarding accuracy and integrity are investigated and resolved: JSC, S-BR, MJK, RS, JWP, SCH, S-YJ, and KJP.

Corresponding author

Correspondence to Seung-Bum Ryoo MD, PhD.

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DISCLOSURE

Jin Sun Choi, Min Jung Kim, Rumi Shin, Ji Won Park, Seung Chul Heo, Seung-Yong Jeong, Kyu Joo Park, and Seung-Bum Ryoo declare that they have no conflicts of interest

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Choi, J.S., Kim, M.J., Shin, R. et al. Risk Factor Analysis of Lymph Node Metastasis for Rectal Neuroendocrine Tumors: Who Needs a Radical Resection in Rectal Neuroendocrine Tumors Sized 1–2 cm?. Ann Surg Oncol 31, 2414–2424 (2024). https://doi.org/10.1245/s10434-023-14829-x

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