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Surgical Endoscopy

, Volume 30, Issue 10, pp 4239–4248 | Cite as

The Ki-67 labeling index and lymphatic/venous permeation predict the metastatic potential of rectal neuroendocrine tumors

  • Shinya Sugimoto
  • Kinichi Hotta
  • Tadakazu Shimoda
  • Kenichiro Imai
  • Yuichiro Yamaguchi
  • Takashi Nakajima
  • Takuma Oishi
  • Keita Mori
  • Kohei Takizawa
  • Naomi Kakushima
  • Masaki Tanaka
  • Noboru Kawata
  • Hiroyuki Matsubayashi
  • Hiroyuki Ono
Article

Abstract

Background

Endoscopic resection has been used to treat small rectal neuroendocrine tumors (NETs). However, the indication for additional surgery after endoscopic resection is unclear. The aim of this study was to identify risk factors for rectal NET metastasis and to determine the indication for additional surgery.

Methods

Fifty-five patients with a total of 57 rectal NETs, treated between October 2003 and January 2013, were retrospectively divided into metastatic (11 lesions) and non-metastatic (46 lesions) groups. Tumor size, central depression, invasion depth, lymphatic and venous permeation, mitotic activity, nuclear abnormality, Ki-67 labeling index, and World Health Organization grading classification (G1 or G2) were compared between the groups. Patients underwent endoscopic submucosal resection with a ligation device, transanal full-thickness surgical resection, or radical surgery.

Results

By univariate analysis, the odds ratios (OR) for a Ki-67 labeling index >3.0 %, positive lymphatic or venous permeation, World Health Organization grading classification G2, tumor size >10 mm, submucosal invasion >4000 μm, and central depression were 120 (P < 0.001), 67.6 (P < 0.001), 58.7 (P < 0.001), 9.8 (P = 0.0037), 6.8 (P = 0.012), and 5.7 (P = 0.018), respectively. Multivariate logistic regression analyses showed that vascular permeation (OR 111; P = 0.006) and a Ki-67 labeling index >3.0 % (OR 88; P = 0.012) were independent risk factors for metastasis.

Conclusions

The Ki-67 labeling index and lymphatic/venous permeation were reliable predictors of rectal NET metastases.

Keywords

Rectal NET Metastasis Predictor Ki-67 labeling index Lymphatic permeation Venous permeation 

Notes

Compliance with ethical standards

Disclosures

Shinya Sugimoto, Kinichi Hotta, Tadakazu Shimoda, Kenichiro Imai, Yuichiro Yamaguchi, Takashi Nakajima, Takuma Oishi, Keita Mori, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Noboru Kawata, Hiroyuki Matsubayashi, and Hiroyuki Ono have disclosed that they have no significant relationships or financial interests with any commercial companies pertaining to this article.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Shinya Sugimoto
    • 1
  • Kinichi Hotta
    • 1
  • Tadakazu Shimoda
    • 2
  • Kenichiro Imai
    • 1
  • Yuichiro Yamaguchi
    • 1
  • Takashi Nakajima
    • 2
  • Takuma Oishi
    • 2
  • Keita Mori
    • 3
  • Kohei Takizawa
    • 1
  • Naomi Kakushima
    • 1
  • Masaki Tanaka
    • 1
  • Noboru Kawata
    • 1
  • Hiroyuki Matsubayashi
    • 1
  • Hiroyuki Ono
    • 1
  1. 1.Division of EndoscopyShizuoka Cancer CenterSuntogunJapan
  2. 2.Divisions of PathologyShizuoka Cancer CenterSuntogunJapan
  3. 3.Divisions of Clinical TrialsShizuoka Cancer CenterSuntogunJapan

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