Development of a novel scoring system based on endoscopic appearance for management of rectal neuroendocrine tumors

Abstract

Background and study aims: The clinical significance of endoscopic appearance of rectal neuroendocrine tumor (NET) was poorly understood. We aimed to develop a novel scoring system based on endoscopic appearances to predict endoscopically advanced disease of patients with rectal NET when initially diagnosed. Patients and methods: Patients diagnosed as well-differentiated rectal NET between January 2005 and December 2019 were retrospectively included. Logistic regression analyses were applied to study the relationship between endoscopic appearance and advanced disease. The whole dataset was randomly divided into training set and validating set, and were used to develop and validate a novel scoring system respectively. Results: In total, 309 patients were included. Endoscopic appearance of rectal NET was significantly associated with advanced disease (P<0.001). A novel scoring system was developed based on endoscopic appearance including tumor size, tumor shape and mucosal surface using training set. The area under curve (AUC) of the scoring system to predict advanced disease was 0.953 (95%CI, 0.915-0.991; P<0.001) and 0.960 (95%CI, 0.905-1.000; P<0.001) in training set and validating set respectively. Furthermore, the scoring system was significantly associated with tumor grade. Patients with high score had significantly worse DFS and OS than patients with low score based on the novel scoring system (P<0.001). Conclusion: The proposed novel scoring system based on endoscopic appearance of primary tumor can help accurately identify patients with endoscopically advanced disease who are not suitable for endoscopic resection. In addition, it is of great value in monitoring tumor recurrence and overall survival of patients with rectal NET.

Tumor Macroscopic Morphology Is an Important Prognostic Factor in Predicting Chemotherapeutic Efficacy and Clinical Outcomes of Patients With Colorectal Neuroendocrine Neoplasms, One Multicenter Retrospective Cohort Study

“…Several previous reports have explored the predictive value of the endoscopic features of NENs, but most of them focused on early, localized lesions less than 2 cm in size ( 21 , 22 ). Normally, endoscopic evaluation for NENs includes an analysis of shape, color, and surface changes (depression, erosion, hemorrhage, ulceration and hyperemia) ( 23 ).…”

Rectal neuroendocrine tumors: is it all on first sight?

“…Prediction of advanced disease [3] 1 Proposed algorithm for the management of a rectal neuroendocrine tumor suspected during initial colonoscopy. This personal view from the authors relies on the current recommendations [5][6] and integrates the score proposed by Chen et al [3] in the present issue of Endoscopy.…”

“…Prediction of advanced disease [3] 1 Proposed algorithm for the management of a rectal neuroendocrine tumor suspected during initial colonoscopy. This personal view from the authors relies on the current recommendations [5][6] and integrates the score proposed by Chen et al [3] in the present issue of Endoscopy. CT, computed tomography; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; EUS, endoscopic ultrasonography; LNM, lymph node metastases; MRI, magnetic resonance imaging; PET, positron emission tomography; TEM, transanal endoscopic microsurgery.…”

“…In the present issue of Endoscopy, Chen and colleagues [3] report the use of the endoscopic appearances of rectal NETs to predict their malignant behavior and prognosis in a retrospective study including 309 consecutive patients with a rectal NET.…”

“…Importantly, rectal NETs predicted to have a low risk of advanced disease (most rectal NETs < 1 cm in size, and some of those < 2 cm) could be good candidates for local resection, although it requires an appropriate resection technique [1,3,4].…”