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Risk Factors for Lymph Node Metastasis of Rectal Neuroendocrine Tumor and Its Prognostic Impact: A Single-Center Retrospective Analysis of 195 Cases with Radical Resection

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

Abstract

Purpose

The incidence of rectal neuroendocrine tumors (NETs) has been steadily increasing. The risk factors for and prognostic impact of lymph node (LN) metastasis were analyzed in 195 patients with stage I–III rectal NET who underwent radical surgery.

Methods

This retrospective, single-center study analyzed risk factors for LN metastasis focusing on previously identified factors and a novel risk factor: multiple rectal NETs. The association between LN metastasis and the prognosis was also analyzed.

Results

Pathologically, the LN metastasis rate (also the rate of stage III disease) was 39%, which was higher than the clinical LN metastasis rate of 14%. Tumor size > 10 mm, presence of central depression, tumor grade G2, depth of invasion, LN swelling on preoperative imaging (cN1), venous invasion and multiple NETs were identified as risk factors for LN metastasis. As the tumor size and risk factors increased, the rate of LN metastasis increased. Among these 7 factors, venous invasion, cN1, and multiple NETs were identified as independent predictors of LN metastasis. LN metastasis of rectal NETs was associated with significantly poor disease-free and disease-specific survival.

Conclusions

As risk factors increase, the potential for rectal NETs to metastasize to the LNs increases and LN metastasis is associated with a poor prognosis. This is the first study to report multiple NETs as a risk factor for LN metastasis. A future study examining the survival benefit of radical surgery accompanying LN dissection compared with local resection is warranted.

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Authors and Affiliations

  1. Gastroenterological Center, Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Yukiharu Hiyoshi MD, PhD, FACS, Nobuya Daitoku MD, PhD, Toshiki Mukai MD, PhD, Toshiya Nagasaki MD, PhD, Tomohiro Yamaguchi MD, PhD, Takashi Akiyoshi MD, PhD & Yosuke Fukunaga MD, PhD

  2. Gastroenterological Center, Department of Lower Gastrointestinal Medicine, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Chihiro Yasue MD, Akiko Chino MD, PhD & Shoichi Saito MD, PhD

  3. Department of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Manabu Takamatsu MD, PhD

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  1. Yukiharu Hiyoshi MD, PhD, FACS
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  2. Nobuya Daitoku MD, PhD
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  3. Toshiki Mukai MD, PhD
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  4. Toshiya Nagasaki MD, PhD
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Correspondence to Yukiharu Hiyoshi MD, PhD, FACS.

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Hiyoshi, Y., Daitoku, N., Mukai, T. et al. Risk Factors for Lymph Node Metastasis of Rectal Neuroendocrine Tumor and Its Prognostic Impact: A Single-Center Retrospective Analysis of 195 Cases with Radical Resection. Ann Surg Oncol 30, 3944–3953 (2023). https://doi.org/10.1245/s10434-023-13348-z

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  • DOI: https://doi.org/10.1245/s10434-023-13348-z

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