Risk factors for lymph node metastasis and indication of local resection in duodenal neuroendocrine tumors

Nakao, Eisuke; Namikawa, Ken; Hirasawa, Toshiaki; Nakano, Kaoru; Tokai, Yoshitaka; Yoshimizu, Shoichi; Horiuchi, Yusuke; Ishiyama, Akiyoshi; Yoshio, Toshiyuki; Nunobe, Souya; Fujisaki, Junko

doi:10.1002/jgh3.12718

Cited by 3 publications

(5 citation statements)

References 25 publications

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“…There are no epidemiological research data on DNETs in China. In recent years, with the continuous improvement of diagnostic technology, the incidence rate of DNETs has increased[ 9 ], but there is still insufficient clinical knowledge and management of DNETs[ 10 ]. This study retrospectively analysed the clinical characteristics and prognosis of single centre confirmed DNET patients to help guide disease management.…”

Section: Discussionmentioning

confidence: 99%

“…In functional DNETs, ZES accounts for a higher proportion, and somatostatin tumours are rare[ 1 , 10 ]. There is only one case of functional DNETs in this centre, which is a ZES patient in the ampullary region.…”

Section: Discussionmentioning

confidence: 99%

“…At present, there is no consensus on the treatment of DNETs, which mainly depends on the size and location of the tumour, histopathology classification and grading, staging, and tumour type[ 10 ]. Surgical removal of DNETs is currently a recommended treatment method[ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical features and prognostic factors of duodenal neuroendocrine tumours: A comparative study of ampullary and nonampullary regions

Fang,

Shi,

Wang

et al. 2024

World J Gastrointest Oncol

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BACKGROUND Duodenal neuroendocrine tumours (DNETs) are rare neoplasms. However, the incidence of DNETs has been increasing in recent years, especially as an incidental finding during endoscopic studies. Regrettably, there is no consensus regarding the ideal treatment of DNETs. Even there are few studies on the clinical features and survival analysis of DNETs. AIM To analyze the clinical characteristics and prognostic factors of patients with duodenal neuroendocrine tumours. METHODS The clinical data of DNETs diagnosed in the First Affiliated Hospital of Air Force Military Medical University from June 2011 to July 2022 were collected. Neuroendocrine tumours located in the ampulla area of the duodenum were divided into the ampullary region group; neuroendocrine tumours in any part of the duodenum outside the ampullary area were divided into the nonampullary region group. Using a retrospective study, the clinical characteristics of the two groups and risk factors affecting the survival of DNET patients were analysed. RESULTS Twenty-nine DNET patients were screened. The male to female ratio was 1:1.9, and females comprised the majority. The ampullary region group accounted for 24.1% (7/29), while the nonampullary region group accounted for 75.9% (22/29). When diagnosed, the clinical symptoms of the ampullary region group were mainly abdominal pain (85.7%), while those of the nonampullary region groups were mainly abdominal distension (59.1%). There were differences in the composition of staging of tumours between the two groups (Fisher's exact probability method, P = 0.001), with nonampullary stage II tumours (68.2%) being the main stage (P < 0.05). After the diagnosis of DNETs, the survival rate of the ampullary region group was 14.3% (1/7), which was lower than that of 72.7% (16/22) in the nonampullary region group (Fisher's exact probability method, P = 0.011). The survival time of the ampullary region group was shorter than that of the nonampullary region group (P < 0.000). The median survival time of the ampullary region group was 10.0 months and that of the nonampullary region group was 451.0 months. Multivariate analysis showed that tumours in the ampulla region and no surgical treatment after diagnosis were independent risk factors for the survival of DNET patients (HR = 0.029, 95%CI 0.004-0.199, P < 0.000; HR = 12.609, 95%CI: 2.889-55.037, P = 0.001). Further analysis of nonampullary DNET patients showed that the survival time of patients with a tumour diameter < 2 cm was longer than that of patients with a tumour diameter ≥ 2 cm (t = 7.243, P = 0.048). As of follow-up, 6 patients who died of nonampullary DNETs had a tumour diameter that was ≥ 2 cm, and 3 patients in stage IV had liver metastasis. Patients with a tumour diameter < 2 cm underwent surgical treatment, and all survived after surgery. CONCLUSION Surgical treatment is a protective factor for prolonging the survival of DNET patients. Compared to DNETs in the ampullary region, patients in the nonampullary region group had a longer survival period. The liver is the organ most susceptible to distant metastasis of nonampullary DNETs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical features and prognostic factors of duodenal neuroendocrine tumours: A comparative study of ampullary and nonampullary regions

Fang,

Shi,

Wang

et al. 2024

World J Gastrointest Oncol

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“…To our knowledge, few studies have constructed models to predict LNM and survival in patients with duodenal malignant tumours via radiomics analysis [ 23 ]. Previous studies have shown that T stage and lymph vessel invasion are independent risk factors for LNM [ 24 – 26 ]. Our results are consistent with the above studies, and it is reasonable that surgery should be performed for DPC in advanced stages.…”

Section: Discussionmentioning

confidence: 99%

Radiomics analysis based on CT for predicting lymph node metastasis and prognosis in duodenal papillary carcinoma

Tang,

Wu,

Jiang

et al. 2024

Insights Imaging

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Objectives Radiomics has been demonstrated to be strongly associated with TNM stage and patient prognosis. We aimed to develop a model for predicting lymph node metastasis (LNM) and survival. Methods For radiomics texture selection, 3D Slicer 5.0.3 software and the least absolute shrinkage and selection operator (LASSO) algorithm were used. Subsequently, the radiomics model, computed tomography (CT) image, and clinical risk model were compared. The performance of the three models was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), calibration plots, and clinical impact curves (CICs). Results For the LNM prediction model, 224 patients with LNM information were used to construct a model that was applied to predict LNM. According to the CT data and clinical characteristics, we constructed a radiomics model, CT imaging model and clinical model. The radiomics model for evaluating LNM status showed excellent calibration and discrimination in the training cohort (AUC = 0.926, 95% CI = 0.869–0.982) and the validation cohort (AUC = 0.872, 95% CI = 0.802–0.941). DeLong’s test demonstrated that the difference among the three models was significant. Similarly, DCA and CIC showed that the radiomics model has better clinical utility than the CT imaging model and clinical model. Our model also exhibited good performance in predicting survival—in line with the findings of the model built with clinical risk factors. Conclusions CT radiomics models exhibited better predictive performance for LNM than models built based on clinical risk characteristics and CT imaging and had comparative clinical utility for predicting patient prognosis. Critical relevance statement The radiomics model showed excellent performance and discrimination for predicting LNM and survival of duodenal papillary carcinoma (DPC). Key Points LNM status determines the most appropriate treatment for DPC. Our radiomics model for evaluating the LNM status of DPC performed excellently. The radiomics model had high sensitivity and specificity for predicting survival, exhibiting great clinical value. Graphical Abstract

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“…Although no consensus has been reached, it has been reported that the risk factors for the metastasis of NAD-NETs are tumors >10 mm in diameter, muscular invasion, poorly differentiated neuroendocrine histology, and lymphovascular invasion ( 20 , 21 ). Nakao et al found that a tumor size ≥10 mm, positive lymphovascular invasion, and 0–Is morphology were significant risk factors for lymph node metastasis ( 22 ). A recent study assessing risk factors for metastases in nonampullary lesions <20 mm in size revealed lymphovascular invasion, tumor size >11 mm and WHO G2 as risk factors for metastatic disease ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumors

Li,

Liu,

Dou

et al. 2024

J Gastrointest Oncol

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Background The incidence rate of duodenal neuroendocrine tumors has been increasing in recent years. Endoscopic resection [ER; endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD)] is recommended for nonampullary duodenal neuroendocrine tumors (NAD-NETs) ≤10 mm in diameter that are confined to the submucosal layer and without lymph node or distant metastasis. However, the efficacy and safety of and indications for EMR/ESD remain unclear. Methods Between November 2011 and April 2021, 12 NAD-NETs in 12 patients who underwent either EMR or ESD were analyzed retrospectively. The rates of en bloc resection, complete resection, pathologic complete resection, margin involvement, lymphovascular invasion, perineural invasion, complications and prognosis were determined during follow-up (median observation period 53.0 months). Results EMR was performed for two tumors, and ESD was performed for ten tumors. En bloc resection was performed for both tumors (100%) in the EMR group, and complete resection was achieved in one case (50%). Pathological complete resection was achieved in one case (50%), while in the ESD group, these three rates were 90% (9/10), 80% (8/10), and 80% (8/10), respectively. Intraoperative perforation occurred in one patient (10%) during ESD treatment, with no intraoperative or delayed bleeding in either group. Recurrence and distant metastasis were not observed during the mean follow-up period of 53.0 months (range, 18–131 months). Conclusions For NAD-NETs that measure ≤10 mm in size, are confined to the submucosal layer and have neither suspicious lymph nodes nor distant metastasis, ER (EMR and ESD) may be a safe, effective, and feasible endoscopic technique for removing them.

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Risk factors for lymph node metastasis and indication of local resection in duodenal neuroendocrine tumors

Cited by 3 publications

References 25 publications

Clinical features and prognostic factors of duodenal neuroendocrine tumours: A comparative study of ampullary and nonampullary regions

Clinical features and prognostic factors of duodenal neuroendocrine tumours: A comparative study of ampullary and nonampullary regions

Radiomics analysis based on CT for predicting lymph node metastasis and prognosis in duodenal papillary carcinoma

Treatment outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumors

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