| Objective To explore the risk factors associated with lymph node metastasis of rectal neuroendocrine tumors(NETs),and develop a model for predicting the risk of lymph node metastasis in rectal NETs.And to determine the risk factors for prognosis of rectal neuroendocrine neoplasms(NENs).Methods The clinicopathological data and follow-up data of 239 patients with rectal NENs were collected.Rectal NETs patients are grouped according to whether they are accompanied by lymph node metastasis,and are divided into lymph node metastasis positive group(LNM+)and lymph node metastasis negative group(LNM-).And then the clinical and pathological data of the two groups were analyzed to seek out the significant factors,and then Logistic regression analysis to find the independent risk factors for lymph node metastasis.And using the classification decision tree model,the rectal NETs patients are divided into high-risk groups and low-risk groups according to the risk of lymph node metastasis.The Kaplan-Meier test system was used to teste the 5-year overall survival(5-OS)and 5-year disease-free survival(5-DFS)of patients with rectal NENs.The differences between groups were tested by Log-rank method.COX univariate regression analysis and multivariate regression analysis were used to explore the prognostic risk factors in patients with T1 colorectal cancer rectal NENs.Result Of 239 patients with rectal NENs,223 were rectal NETs,and 16 were rectal neuroendocrine carcinoma(NEC).1.In rectal NETs,24 had lymph node metastasis Positive,Univariate analysis showed that age,tumor size,WHO grade,depth of invasion,lymphatic or vascular invasion and perineural invasion were related risk factors for rectal NET lymph node metastasis(P <0.05).Multivariate analysis showed that the independent risk factors were: tumor size(>2cm,OR=14.659,95%CI: 1.082-198.577,P=0.043),WHO grade(G2,OR=10.033,95%CI: 2.221-45.322,P=0.002)and the depth of tumor invasion(invades muscularis propria,OR=9.362,95%CI: 1.762-49.758,P=0.009;invades muscularis propria or deeper,OR=13.636,95%CI: 1.778-104.565,P=0.012).ROC analysis showed that the area under the curve was 0.948,95CI%: 0.890-1.000,P<0.001.2.According to the different risks of lymph node metastasis,classification decision tree divides rectal NETs patients into low-risk groups and high-risk groups,the lymph node metastasis rates of patients in the low-risk group and high-risk group were1.1% and 56.4%,respectively.We recommend local resection for patients in the low-risk group and radical surgery for patients in the high-risk group.3.The 5-year overall survival rate of patients with rectal NENs was 90.8%,and the 5-year disease-free survival rate was 88.5%.Univariate analysis showed that the risk factors affecting the OS and DFS of patients with rectal NENs were tumor size,WHO grade,depth of invasion,lymphatic or vascular invasion.In addition,age is a risk factor affecting the OS of patients with rectal NENs.Multivariate analysis showed that lymph node metastasis(HR=9.789,95%CI=1.042-91.932,P=0.046)and lymphatic or vascular invasion(HR=14.059,95%CI=3.159-62.565,P=0.001)were independent factors affecting the OS.Lymph node metastasis(HR=8.728,95%CI=1.744-43.682,P=0.008)and lymphatic or vascular invasion(HR=14.119,95%CI=3.335-59.776,P=0.001)were independent factors affecting the DFS.Conclusion 1.Tumor size,WHO grade and the depth of tumor invasion are independent risk factors for rectal NETs lymph node metastasis.2.For G1 patients whose tumor has not infiltrated into the muscle layer,even if the size is greater than 2 cm,local resection can be considered.G2 patients whose tumor has not infiltrated into the muscle layer can only be considered for local resection when the size is less than 1 cm.Radical surgery is recommended for tumors that infiltrate into the muscle layer,regardless of size or grade.3.Lymph node metastasis and lymphatic or vascular invasion are independent risk factors that affect the prognosis of rectal NENs. |
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