Lymphovascular invasion as a prognostic value in small rectal neuroendocrine tumor treated by local excision: A systematic review and meta-analysis

Kang, Ho Suk; Kwon, Mi Jung; Kim, Tae Hwan; Han, Junhee; Ju, Young‐Su

doi:10.1016/j.prp.2019.152642

Cited by 31 publications

(38 citation statements)

References 33 publications

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“…They showed that endoscopically resected rectal NETs with a non-curative resection had a good prognosis, regardless of additional salvage treatments, while patients with lymphovascular invasion needed to undergo radical surgery with lymph node dissection. The risk factors for lymph node metastasis are tumor size >14 mm, increased mitotic rate, and lymphovascular invasion; also small rectal NETs can have lymphovascular invasion and subsequent lymph node metastasis, but they tend to have excellent short-term prognosis, with only an 0.3% recurrence rate during the 5-year follow-up period, and they do not require surgical intervention, but only a long-term follow up of 10 to 20 years to assess for any delayed recurrence, as demonstrated in the meta-analysis conducted by Kang et al [ 62 ].…”

Section: Management Of Rectal Netsmentioning

confidence: 99%

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

et al. 2021

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Rectal neuroendocrine tumors (NETs) are rare, with an incidence of 0.17%, but they represent 12% to 27% of all NETs and 20% of gastrointestinal NETs. Although rectal NETs are uncommon tumors, their incidence has increased over the past few years, and this is probably due to the improvement in detection rates made by advanced endoscopic procedures. The biological behavior of rectal NETs may be different: factors predicting the risk of metastases have been identified, such as size and grade of differentiation. The tendency for metastatic diffusion generally depends on the tumor size, muscular and lymphovascular infiltration, and histopathological differentiation. According to the current European Neuroendocrine Tumor Society (ENETS) guidelines, tumors that are smaller than 10 mm and well differentiated are thought to have a low risk of lymphovascular invasion, and they should be completely removed endoscopically. Rectal NETs larger than 20 mm have a higher risk of involvement of muscularis propria and high metastatic risk and are candidates for surgical resection. There is controversy over rectal NETs of intermediate size, 10–19 mm, where the metastatic risk is considered to be 10–15%: assessment of tumors endoscopically and by endoanal ultrasound should guide treatment in these cases towards endoscopic, transanal, or surgical resection.

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Section: Management Of Rectal Netsmentioning

confidence: 99%

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

et al. 2021

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“…Lymphovascular and perineural invasion had no statistical signi cance in the present study; however, they were observed in higher percentage (28.6% and 42.9%, respectively) in patients with metastasis (vs. 5.9% in those in the non-metastatic group). A meta-analysis showed that lymphovascular invasion was a risk factor for lymph node metastasis [15]. Concerning the small sample size in the present study, type II error might occur, and an increase in the sample size may demonstrate a statistical signi cance for these factors.…”

Section: Discussionmentioning

confidence: 60%

Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor 

Park¹,

Cho²,

Son³

et al. 2020

Preprint

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Background: Rectal neuroendocrine tumors (NET) <10 mm are typically treated with endoscopic resection, while those >20 mm should be treated with radical surgical resection. However, the proper treatment methodology for 10-20-mm sized rectal NETs remains controversial. The purpose of this study was to investigate the appropriate treatment strategy for 10-20-mm sized rectal NETs by verifying factors that can predict metastasis.Methods: A total of 24 patients with 10–20-mm sized NETs who were treated at Pusan National University Yangsan Hospital from January 2009 to September 2020 were included. The patients were divided into the metastasis and non-metastasis groups, and their respective data were analyzed.Results: Seven patients had metastasis (29.2%) while 17 patients had no metastasis (70.8%). The tumor size, based on the endorectal ultrasound (EUS) findings, was significantly larger in the metastatic than in the non-metastatic group (14.4 vs. 10.2 mm, p = 0.029); however, the pathological tumor size did not show significant differences (13.3 vs. 11.8 mm, p = 0.065). Lymph node enlargement was observed in a single patient (14.3%) in the metastatic group, based on EUS and computed tomography (CT) imaging findings. The mitotic count (p = 0.017) and Ki-67 index (p = 0.014) were significantly higher in the metastatic group than in the non-metastatic group. The two groups also showed a significant difference in the proportion of patients with tumor grade 2 (71.4% vs. 5.9%, p = 0.003). In multivariate analysis, the tumor grade was the only independent metastasis-predicting factor (odds ratio = 49.25; 95% confidence interval = 2.55–950.83; p = 0.010). Conclusions: Regarding the treatment of 10–20-mm sized rectal NETs, tumor grade 2 should be the most important factor to determine whether additional radical resection is necessary.

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“…According to different degrees of pathological differentiation, NENs were divided into well‐differentiated NETs, poorly differentiated NETs, and mixed neuroendocrine and/or non‐NETs with both adenocarcinoma and neuroendocrine components 13‐16 . Because of great differences in biological behavior between NET and NEC, the 8th edition of the AJCC staging system focused on NETs, mainly aimed at NET, while NEC staging was based on the criteria of adenocarcinoma at the corresponding site 17‐21 . In this study, we evaluated the survival of NEC patients based on the 8th colorectal cancer staging system, including the analysis of patients with carcinoid tumor NOS and OCT.…”

Section: Discussionmentioning

confidence: 99%

“…It was generally accepted that tumors larger than 2 cm required radical surgery and associated lymphoid tissues should be dissected in order to look for possible lymph node metastases 11 . However, the treatment of tumors smaller than 2 cm in diameter was controversial all the time 19 . Although a metastatic rate of 4%‐30% was reported, for rectal carcinoid tumors with diameters between 1 and 2 cm, the metastatic status still could not be predictable 25 .…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16] Because of great differences in biological behavior between NET and NEC, the 8th edition of the AJCC staging system focused on NETs, mainly aimed at NET, while NEC staging was based on the criteria of adenocarcinoma at the corresponding site. [17][18][19][20][21] In this study, we evaluated the survival of NEC patients based on the 8th colorectal cancer staging system, including the analysis of patients with carcinoid tumor NOS and OCT.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic significance for colorectal carcinoid tumors based on the 8th edition TNM staging system

et al. 2020

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The aim of our study was to explore the value of the 8th edition TNM staging system on evaluating the prognosis of colorectal carcinoid. Colorectal carcinoid patients between 1988 and 2015 were selected in the Surveillance, Epidemiology, and End Results Program (SEER) database for analysis. About 4286 patients with colorectal carcinoid tumors were identified, of which were carcinoid tumor NOS (n = 1726), neuroendocrine carcinoma (NEC) (n = 1346) and other carcinoid tumor (OCT) (n = 591). Worsening 10‐year CSS rates with increasing N status, M status, and SEER historic stage were demonstrated across all three above groups (all P < .05). In carcinoid tumor NOS, significant differences in CSS were found with increasing combined 8th AJCC stages (P < .001), except for that between stage II and stage III (10‐year CSS rate: 82.6% vs 84.3%, P = .68). While combined 8th TNM stage in NEC and OTC exhibited greater separations in CSS despite on‐going overlaps between groups. For carcinoid tumor NOS, stage II (HR = 3.37; 95% CI: 0.97‐11.76), and stage III (HR = 2.09; 95% CI: 0.51‐8.66) conferred no significant difference in CSS compared with stage I, while stage IV had an increasing HR of 5.09 (95% CI: 1.08‐24.08). Although combined 8th AJCC stage had a good ability to distinguish 10‐year CSS of patients with NEC or OCT, detailed 8th AJCC stage did not seem to be applicable. Detailed 8th AJCC categories of advanced stages in all the three groups conferred increased HRs with overlapping CIs. However, in the early and middle status, HRs did not increase with the increase of stages, or there was no difference in HRs between adjacent stages. Combined 8th TNM stage was not practical for judging the survival outcomes of colorectal carcinoid tumor NOS, especially in patients with stages II and III, but it provided useful prognostic information for NEC and OCT. However, for all carcinoid tumors, the prognostic values of detailed 8th AJCC stage were not enough accurate in the clinic. More optimized staging methods should be developed and validated in the future.

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Lymphovascular invasion as a prognostic value in small rectal neuroendocrine tumor treated by local excision: A systematic review and meta-analysis

Cited by 31 publications

References 33 publications

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor

Prognostic significance for colorectal carcinoid tumors based on the 8th edition TNM staging system

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Lymphovascular invasion as a prognostic value in small rectal neuroendocrine tumor treated by local excision: A systematic review and meta-analysis

Cited by 31 publications

References 33 publications

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)

Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor&nbsp;

Prognostic significance for colorectal carcinoid tumors based on the 8th edition TNM staging system

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Factors predicting metastasis in patients with 10–20-mm sized rectal neuroendocrine tumor