| Part 1 Risk factors for lymph node metastasis and prognosis in colorectal neuroendocrine neoplasmsObjective: The detection rate of colorectal neuroendocrine neoplasms is increasing,but its treatment is still controversial.Lymph node metastasis is an important reference index for treatment selection.The objective of this study was to investigate the risk factors for lymph node metastasis and the prognostic factors in colorectal neuroendocrine neoplasms.Methods: The clinicopathological characteristics of patients with colorectal neuroendocrine neoplasms from January 2011 to December 2020 were retrospectively analyzed,including age,gender,tumor size,tumor location,lymph node metastasis,pathological grade,and follow-up.Then go to analyze the risk factors for lymph node metastasis and the prognostic factors in colorectal neuroendocrine neoplasms.Results:1.A total of 195 patients with colorectal neuroendocrine neoplasms were included in this study,including 31(15.9%)colonic neoplasms and 164(84.1%)rectal neoplasms.The median age was 56 years,and the male to female ratio was 120(61.5%):75(38.5%).At the critical value of 15 mm,the sensitivity,specificity and AUC of lymph node metastasis were 95.9%,95.2%and 0.986 respectively.2.Univariate analysis showed that the rate of lymph node metastasis was significantly correlated with age(P < 0.001),tumor size(P < 0.001),tumor location(P < 0.001),lymphatic vessel invasion(P < 0.001),musculus propria invasion(P < 0.001),and lymph node metastasis(P < 0.001).Ki 67 index(P< 0.001)and Cg A(P < 0.001)were statistically different.Multivariate analysis suggested tumor size ≥ 15 mm(OR: 30.517,95%CI: 1.250～744.996,P = 0.036)and lymphatic vascular invasion(OR: 42.796,95%CI: 2.882～635.571,P = 0.006)were independent risk factors for lymph node metastasis of colorectal neuroendocrine neoplasms.3.Univariate analysis indicated age(P = 0.009),tumor size(P = 0.009),tumor location(P < 0.001),lymphatic vascular invasion(P = 0.022),musculus propria invasion(P < 0.001),Ki-67 index(P < 0.001),Cg A(P =0.006),lymph node metastasis(P = 0.016)and distant metastasis(P < 0.001)were correlated with the prognosis of colorectal neuroendocrine neoplasms.Multivariate analysis suggested age ≥56 years(HR: 7.434,95% confidence interval: 1.334～41.443,P = 0.022)and distant metastasis(HR: 24.487,95%confidence interval: 5.357～111.940,P < 0.001)were independent prognostic factors for colorectal neuroendocrine neoplasms.Summary:1.Tumor size ≥15mm and lymphatic vascular infiltration were independent risk factors for lymph node metastasis of colorectal neuroendocrine neoplasms.2.Age greater than 56 years and distant metastasis were independent prognostic factors for patients with colorectal neuroendocrine neoplasms.Part 2 Comparison between endoscopic mucosal resection with a cap and endoscopic submucosal dissection for rectal neuroendocrine neoplasms and analysis of risk factors for incomplete resectionObjective: Rectal neuroendocrine neoplasms can be found serendipitously without symptoms and have a good prognosis.Current guidelines recommend endoscopic resection for small rectal neuroendocrine neoplasms confined to the mucosal layer or submucosal layer without lymph node metastasis.There are many methods of endoscopic resection.In our study,we want to compare the safety and efficacy between endoscopic mucosal resection with a cap and endoscopic submucosal dissection in retal neuroendocrine neoplasmsr,and to analysis of the risk factors of incomplete resection.Then to provide experience basis for clinical diagnosis and treatment of rectal neuroendocrine neoplasms.Methods: We collected clinicopathological characteristics of 122 patients with pathologically confirmed rectal neuroendocrine neoplasms who underwent surgical resection in the Department of Endoscopy,the Fourth Hospital of Hebei Medical University from February 2007 to December 2020,including gender,age,chief complaint,lesion site,lesion size,infiltration depth,ultrasound source,pathological classification,positive rate of markers in the immune group,postoperative colonoscopy follow-up results,etc.The operative information included the operative time,complications(including infection,perforation,and delayed bleeding),en bloc resection rate,and pathologically complete resection rate,etc.The safety and effectiveness of the two methods for resection of rectal neuroendocrine neoplasms were compared,and the risk factors for incomplete resection were analyzed.Results:1.A total of 122 patients with a total of 128 lesions were included in this study.Among them,67 patients had no obvious clinical manifestations,which were found in physical examination;22 patients had abdominal distension and abdominal pain,21 patients complained of changes in stool habits(including diarrhea and constipation),7 patients complained of perianal discomfort,and5 patients came to the hospital because of positive occult blood.Among all cases,71 were males and 51 were females,aged 20-69 years,with an average age of 52 years.The neoplasms were mostly in the middle and lower rectum,and NET G1 was the most common pathologic type.2.The operative time of endoscopic mucosal resection with a cap was significantly shorter than that of endoscopic submucosal dissection(P< 0.001).There were no significant difference in en bloc resection rate(97.5% vs.100%),complete resection rate(85% vs.77.08%)and complication rate(2.5% vs.2.5%)between the two groups.3.Analysis of pathological features between the complete resection group and the incomplete resection group showed that there was a statistically significant difference in the size of lesions between the two groups(P =0.018).Multivariate analysis showed tumor size ≥8 mm(OR: 3.419;95% CI: 1.295 ～9.026,P =0.013)was an independent risk factor for endoscopic incomplete resection in rectal neuroendocrine tumors patients in this study.Summary:1.Rectal neuroendocrine neoplasms mostly have no specific clinical manifestations.They were most common in men,mostly occurring in the middle and lower rectum,mostly confined to the mucosa or submucosa,and G1 was the most common pathological type.2.Endoscopic mucosal resection with a cap and endoscopic submucosal dissection were both safe and effective treatments for rectal neuroendocrine tumors with diameters less than 15 mm.3.Tumor diameter ≥8mm was an independent risk factor for endoscopic incomplete resection in rectal neuroendocrine neoplasms patients.Part 3 Clinicopathological analysis of rectal multiple neuroendocrine neoplasms and literature reviewObjective: According to the statistics of existing data,the incidence of rectal multiple neuroendocrine neoplasms is 2% ～ 5.7%,belong to rare disease.At present,there are only a few epidemiological reports available for reference,and the clinicopathological features are not yet clear.Therefore,no consensus has been reached on the treatment of rectal multiple neuroendocrine neoplasms.In this study,the clinicopathological characteristics of rectal multiple neuroendocrine neoplasms were reviewed,and the clinical diagnosis and treatment of rectal multiple neuroendocrine neoplasms were preliminarily discussed based on literature reports.Methods: This study retrospectively analyzed rectal neuroendocrine tumors diagnosed and treated in the Fourth Hospital of Hebei Medical University from February 2007 to May 2021.At the same time,the clinicopathological characteristics of rectal multiple neuroendocrine neoplasms were summarized and analyzed in combination with 14 literatures on rectal multiple neuroendocrine neoplasms,so as to understand the risk factors of lymph node metastasis of rectal multiple neuroendocrine neoplasms.Results:1.A total of 183 patients with rectal neuroendocrine neoplasms were included in this study,including 176 patients(96.2%)with single neuroendocrine neoplasm and 7 patients(3.8%)with multiple neuroendocrine neoplasms.2.There were 4 males(57.1%)and 3 females(42.9%)with rectal multiple neuroendocrine neoplasms.The median age was 49(46-69)years.There were a total of 17 tumors,including 2 tumors in 6 cases and 5 tumors in1 case,all of which were less than 10 mm in size.All tumors invaded the submucosa.No lymph node metastasis or distant metastasis was found in preoperative examination of all tumors.Endoscopic resection was performed in all tumors and complete resection was performed.There were 13 tumors in G1 grade,2 in G2 grade and 1 in ungraded grade.No tumor recurrence or metastasis occurred during follow-up.3.Combined with 14 literatures reviewed,there were 47 cases of rectal multiple neuroendocrine neoplasms.Among these cases,29 were males(61.7%)and 18 were females(38.3%),aged between 32 and 81 years.The neoplasm size was generally less than 10 mm,and the number of neoplasms ranged from 2 to 69,34 cases(72.3%)had less than 8,and 13 cases(27.7%)had more than 8.There were 45 cases(95.7%)of tumors invaded the submucosa,and 2 cases(4.3%)were confined to the mucosa.There were 29(61.7%)patients with G1 grade,3(6.4%)patients with G2 grade,and 15(31.9%)patients with ungraded neoplasm.There were 8 cases(17.0%)with lymph node metastasis,38 cases(80.9%)without lymph node metastasis,and1 case(2.1%)with unclear lymph node metastasis.There were 44 cases(93.6%)without distant metastasis,and 3 cases(6.4%)with unclear distant metastasis.In terms of tumor treatment plan,1 case(2.1%)was followed up,1case(2.1%)was unknown,and the rest cases(95.8%)were surgically excised(the specific method could not be counted).4.In the analysis of 46 cases with known lymph node metastasis,the difference in lymph node metastasis rate between the number of tumors < 8and ≥ 8 groups was statistically significant(P <0.002).Summary:1.In this study,the incidence of rectal multiple neuroendocrine neoplasms accounted for 3.8% of all rectal neuroendocrine neoplasms.There were more males than females,and the number of neoplasms varied,with the size of neoplasms basically no more than 10 mm,and there were more G1 grade tumors.2.For rectal multiple neuroendocrine neoplasms,when the number of tumors ≥ 8,the lymph node metastasis rate was higher.The influence of the number of tumors on lymph node metastasis should be considered in the selection of treatment.Conclusions:1.Tumor size ≥15mm and lymphatic vascular infiltration were independent risk factors for colorectal neuroendocrine neoplasms lymph node metastasis.Age ≥56 years and distant metastasis were independent prognostic factors for patients with colorectal neuroendocrine neoplasms.2.Rectal neuroendocrine neoplasms was rarely seen in clinic with no specific clinical manifestations.Endoscopic mucosal resection with a cap and endoscopic submucosal dissection were both safe and effective treatments for rectal neuroendocrine tumors with diameter less than 15 mm.Tumor diameter≥8mm was an independent risk factor for incomplete endoscopic resection in rectal neuroendocrine neoplasms.3.In this study,the incidence of rectal multiple neuroendocrine neoplasms accounted for 3.8% of all rectal neuroendocrine neoplasms,among which there were more tumors in males than in females,and the number of tumors varied more or less,with the size of tumors basically no more than10 mm,and there were more G1 grade tumors.For rectal multiple neuroendocrine neoplasms,lymph node metastasis rate was higher when the number of tumors ≥ 8.The influence of the number of tumors on lymph node metastasis should be considered in the selection of treatment. |
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