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Abboud Y, Pendyala N, Le A, Mittal A, Alsakarneh S, Jaber F, Hajifathalian K. The Incidence of Rectal Neuroendocrine Tumors Is Increasing in Younger Adults in the US, 2001-2020. Cancers (Basel) 2023; 15:5286. [PMID: 37958459 PMCID: PMC10650543 DOI: 10.3390/cancers15215286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Prior non-comparative data showed increasing incidence of rectal neuroendocrine tumors (RNET) in the US. We aimed to evaluate age-specific RNET incidence rates and time-trends in demographic- and tumor-specific populations. The RNET age-adjusted incidence rates were calculated from the United States Cancer Statistics (USCS) database between 2001 and 2020. The population was stratified by age into older (≥55 years) and younger adults (<55 years), as well as by sex and race. The tumors were categorized by their stage at diagnosis into early and late. The annual percentage change (APC) and average APC (AAPC) were estimated using joinpoint regression and Monte Carlo permutation analysis. Pairwise comparison assessed for parallelism and coincidence. There were 59,846 patients diagnosed with RNET between 2001 and 2020 (50.3% women). Overall, the RNET incidence rates during this period were increasing in younger but not older adults (AAPC = 3.12 vs. -1.10; AAPC difference = 4.22, p < 0.001), with non-identical non-parallel data (p-values < 0.001). While similar results were seen in men, a greater age-specific difference was noted in women (AAPC = 3.31 vs. -1.10; AAPC difference = 4.41, p = 0.003). The difference between younger and older adults was seen in non-Hispanic White (AAPC-difference = 4.89; p < 0.001) and non-Hispanic Black (AAPC-difference = 3.33; p = 0.03) patients, and, in most years, among Hispanic and Non-Hispanic Asian/Pacific Islander patients, and it was mostly driven by early-stage tumors (AAPC-difference = 3.93; p < 0.001). The nationwide data show a significantly increasing RNET incidence in younger adults, most notably in younger women and in early-stage tumors, seen in various races. Future studies should evaluate RNET risk factors and outcomes in demographic-specific populations.
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Affiliation(s)
- Yazan Abboud
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; (N.P.); (A.L.); (A.M.)
| | - Navya Pendyala
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; (N.P.); (A.L.); (A.M.)
| | - Alexander Le
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; (N.P.); (A.L.); (A.M.)
| | - Anmol Mittal
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA; (N.P.); (A.L.); (A.M.)
| | - Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.A.); (F.J.)
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.A.); (F.J.)
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA;
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Li Y, Guo Y, Cheng Z, Tian C, Chen Y, Chen R, Yu F, Shi Y, Su F, Zhao S, Wang Z, Luo J, Tan H. Whole-exome sequencing of rectal neuroendocrine tumors. Endocr Relat Cancer 2023; 30:e220257. [PMID: 36645718 PMCID: PMC10450454 DOI: 10.1530/erc-22-0257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/13/2023] [Indexed: 01/17/2023]
Abstract
The genetic characteristics of rectal neuroendocrine tumors (R-NETs) were poorly understood. Depicting the genetic characteristics may provide a biological basis for prognosis prediction and novel treatment development. Tissues of 18 R-NET patients were analyzed using whole-exome sequencing. The median tumor mutation burden (TMB) and microsatellite instability (MSI) were 1.15 Muts/MB (range, 0.03-23.28) and 0.36 (range, 0.00-10.97), respectively. Genes involved in P53 signaling, PI3K-AKT signaling, DNA damage repair, WNT signaling, etc. were frequently altered. Higher TMB (P = 0.078), higher CNV (P = 0.110), somatic mutation of CCDC168 (P = 0.049), HMCN1 (P = 0.040), MYO10 (P = 0.007), and amplification of ZC3H13 (P < 0.001) were associated with shorter OS. Potentially targetable gene alterations (PTGAs) were seen in 72% of the patients. FGFR1 amplification (22%) was the most common PTGA followed by BARD1 and BRCA2 mutation (each 17%). As for gene variations associated with the efficacy of immune checkpoint blockade (ICB), FAT1 alteration (39%) and PTEN depletion (28%) were commonly observed. In conclusion, frequently altered oncogenic pathways might contribute to the development and progression of R-NETs. Gene alterations significantly associated with prognosis might be potential novel targets. Targeted therapy might be a promising strategy as targetable alterations were prevalent in R-NETs. FAT1 alteration and PTEN depletion might be the main genetic alterations influencing the response to ICB besides overall low TMB and MSI in R-NETs.
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Affiliation(s)
- Yuanliang Li
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yiying Guo
- Department of Integrative Oncology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zixuan Cheng
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Tian
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yingying Chen
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ruao Chen
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fuhuan Yu
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yanfen Shi
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Fei Su
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Shuhua Zhao
- Department of Biological Information Research, HaploX Biotechnology Co., Ltd, Shenzhen, Guangdong, China
| | - Zhizheng Wang
- Academic Department, HaploX Biotechnology, Co., Ltd, Shenzhen, Guangdong, China
| | - Jie Luo
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Huangying Tan
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing University of Chinese Medicine, Beijing, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
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3
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Srirajaskanthan R, Clement D, Brown S, Howard MR, Ramage JK. Optimising Outcomes and Surveillance Strategies of Rectal Neuroendocrine Neoplasms. Cancers (Basel) 2023; 15:2766. [PMID: 37345103 DOI: 10.3390/cancers15102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/05/2023] [Accepted: 05/05/2023] [Indexed: 06/23/2023] Open
Abstract
Rectal neuroendocrine neoplasms are increasing in incidence, in part due to increased endoscopic procedures being performed for bowel cancer screening. Whilst most of these lesions are low-grade well-differentiated neuroendocrine tumours, they can have a varied clinical behaviour. Frequently, these lesions are incorrectly characterised at endoscopy and, therefore, incompletely excised using standard polypectomy techniques. Furthermore, some cases are not fully staged prior to or post resection. In this article we discuss the endoscopic and surgical options available to improve the likelihood of achieving an R0 resection and the staging procedures that should be used in these NETs. We also review factors that may suggest a higher risk of nodal involvement or recurrence. This information may help determine whether endoscopic or surgical resection techniques should be considered. In cases of R1 resection we discuss the management options available and the long-term surveillance options and when these should be offered to patients.
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Affiliation(s)
- Rajaventhan Srirajaskanthan
- Kings Health Partners, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London SE5 9RS, UK
- Department of Gastroenterology, King's College Hospital, London SE5 9RS, UK
| | - Dominique Clement
- Kings Health Partners, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London SE5 9RS, UK
- Department of Gastroenterology, King's College Hospital, London SE5 9RS, UK
| | - Sarah Brown
- Kings Health Partners, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London SE5 9RS, UK
- Department of Gastroenterology, King's College Hospital, London SE5 9RS, UK
| | - Mark R Howard
- Department of Histopathology, Kings Health Partners, ENETS Centre of Excellence, King's College Hospital, London SE5 9RS, UK
| | - John K Ramage
- Kings Health Partners, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London SE5 9RS, UK
- Department of Gastroenterology, Hampshire Hospitals NHS Foundation Trust, Basingstoke RG24 9NA, Hampshire, UK
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Zhuang X, Zhang S, Chen G, Luo Z, Hu H, Huang W, Guo Y, Ouyang Y, Peng L, Qing Q, Chen H, Li B, Chen J, Wang X. Risk factors and clinical outcomes of incomplete endoscopic resection of small rectal neuroendocrine tumors in southern China: a 9-year data analysis. Gastroenterol Rep (Oxf) 2022; 11:goac084. [PMID: 36632622 PMCID: PMC9825708 DOI: 10.1093/gastro/goac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 01/09/2023] Open
Abstract
Background The histologically complete resection (CR) rate of small rectal neuroendocrine tumors (RNETs) is unsatisfactory at the first endoscopy. Risk factors and clinical outcomes associated with incomplete resection (IR) have not been explicitly elucidated. This study aims to explore the relevant factors of IR. Methods This retrospective study reviewed patients with small RNETs (≤10 mm) in eight centers from January 2013 to December 2021. Clinicopathological characteristics and clinical outcomes were compared between the CR and IR groups, and the polypectomy and advanced treatment groups. Results Of the 326 patients included, 83 (25.5%) were diagnosed with IR. Polypectomy (odds ratio [OR] = 16.86), a central depression (OR = 7.50), and treatment in the early period (OR = 2.60) were closely associated with IR. Further analysis revealed that an atypical hyperemic appearance (OR = 7.49) and treatment in the early period (OR = 2.54) were significantly associated with the inappropriate use of polypectomy (both P < 0.05). In addition, a total of 265 (81.3%) were followed up with a median follow-up period of 30.9 months. No death, metastasis, or recurrence was found during the follow-up period. Conclusions Polypectomy, a central depression, and treatment in the early period were risk factors for IR. Further, an atypical hyperemic appearance and treatment in the early period were significant predisposing factors for inappropriate choice of polypectomy. For histologically incompletely resected small RNETs, follow-up may be a safe and feasible alternative to rigorous salvage therapy.
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Affiliation(s)
| | | | - Guiquan Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, P. R. China
| | - Zongqi Luo
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, P. R. China
| | - Huiqin Hu
- Department of Gastroenterology, Huizhou First Hospital, Huizhou, P. R. China
| | - Wenfeng Huang
- Department of Gastroenterology, Huizhou First Hospital, Huizhou, P. R. China
| | - Yu Guo
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Yongwen Ouyang
- Department of Digestive Diseases, The First People's Hospital of Foshan, Foshan, P. R. China
| | - Liang Peng
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, P. R. China
| | - Qing Qing
- Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, P. R. China
| | - Huiting Chen
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, P. R. China
| | - Bingsheng Li
- Corresponding authors. Bingsheng Li, Department of Gastroenterology, Huizhou First Hospital, Huizhou 516000, P. R. China. Tel: +86-752-2883877; ; Jie Chen, Department of Head & Neck Tumors and Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China. Tel: +86-21-64175590; ; Xinying Wang, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, 253 Industrial Road, Haizhu District, Guangzhou 510000, P. R. China. Tel: +86-20-62782273;
| | - Jie Chen
- Corresponding authors. Bingsheng Li, Department of Gastroenterology, Huizhou First Hospital, Huizhou 516000, P. R. China. Tel: +86-752-2883877; ; Jie Chen, Department of Head & Neck Tumors and Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China. Tel: +86-21-64175590; ; Xinying Wang, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, 253 Industrial Road, Haizhu District, Guangzhou 510000, P. R. China. Tel: +86-20-62782273;
| | - Xinying Wang
- Corresponding authors. Bingsheng Li, Department of Gastroenterology, Huizhou First Hospital, Huizhou 516000, P. R. China. Tel: +86-752-2883877; ; Jie Chen, Department of Head & Neck Tumors and Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China. Tel: +86-21-64175590; ; Xinying Wang, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, 253 Industrial Road, Haizhu District, Guangzhou 510000, P. R. China. Tel: +86-20-62782273;
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Zhang Y, Zhang Y, Yang Y, Xu Z, Gao C, Liu M, Zhu W, Zhao H, Zhou H. Case report: Indocyanine green fluorescence-guided imaging in laparoscope, a more sensitive detection technique of lateral lymph nodes metastases from rectal neuroendocrine tumors. Front Oncol 2022; 12:1101990. [PMID: 36591455 PMCID: PMC9800599 DOI: 10.3389/fonc.2022.1101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background The diagnosis and surgical strategy of lateral lymph node metastases of rectal neuroendocrine tumors are still controversial. At present, the major diagnostic means rely on imaging examinations, but will be affected by the size of lymph nodes leading to false negativity. We provide a new technique to determine lateral lymph node metastases during surgery. Clinical case A 68-year-old man developed abdominal pain, bloating and fever for a month. Colonoscopy revealed the mass is 2.4 cm x 2.0 cm in size, with a wide stratum, poor mobility, and a rough but intact surface mucosa. Therefore, rectal neuroendocrine tumors (R-NET) were diagnosed. Multiple imaging methods, such as CT, octreotide imaging and endoscopic ultrasonography, have not found lateral lymph node metastases from rectal neuroendocrine tumors. But indocyanine green (ICG)-enhanced near-infrared fluorescence-guided imaging during surgery found left lateral lymph nodes metastases, which was proved by postoperative pathological examination. Conclusions We believe that applying ICG-enhanced near-infrared fluorescence-guided imaging in laparoscope can improve the detection of positive LLNs in those R-NET patients who did not reveal LNM on imaging examinations.
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Affiliation(s)
- Yueyang Zhang
- Department of Colorectal Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Zhang
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yang
- Department of Hepatobiliary Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Xu
- Department of Colorectal Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changyuan Gao
- Department of Colorectal Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meixi Liu
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjia Zhu
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cheng X, Li J, Xu T, Li K, Li J. Predicting Survival of Patients With Rectal Neuroendocrine Tumors Using Machine Learning: A SEER-Based Population Study. Front Surg 2021; 8:745220. [PMID: 34805260 PMCID: PMC8595336 DOI: 10.3389/fsurg.2021.745220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The number of patients diagnosed with rectal neuroendocrine tumors (R-NETs) is increasing year by year. An integrated survival predictive model is required to predict the prognosis of R-NETs. The present study is aimed at exploring epidemiological characteristics of R-NETs based on a retrospective study from the Surveillance, Epidemiology, and End Results (SEER) database and predicting survival of R-NETs with machine learning. Methods: Data of patients with R-NETs were extracted from the SEER database (2000–2017), and data were also retrospectively collected from a single medical center in China. The main outcome measure was the 5-year survival status. Risk factors affecting survival were analyzed by Cox regression analysis, and six common machine learning algorithms were chosen to build the predictive models. Data from the SEER database were divided into a training set and an internal validation set according to the year 2010 as a time point. Data from China were chosen as an external validation set. The best machine learning predictive model was compared with the American Joint Committee on Cancer (AJCC) seventh staging system to evaluate its predictive performance in the internal validation dataset and external validation dataset. Results: A total of 10,580 patients from the SEER database and 68 patients from a single medical center were included in the analysis. Age, gender, race, histologic type, tumor size, tumor number, summary stage, and surgical treatment were risk factors affecting survival status. After the adjustment of parameters and algorithms comparison, the predictive model using the eXtreme Gradient Boosting (XGBoost) algorithm had the best predictive performance in the training set [area under the curve (AUC) = 0.87, 95%CI: 0.86–0.88]. In the internal validation, the predictive ability of XGBoost was better than that of the AJCC seventh staging system (AUC: 0.90 vs. 0.78). In the external validation, the XGBoost predictive model (AUC = 0.89) performed better than the AJCC seventh staging system (AUC = 0.83). Conclusions: The XGBoost algorithm had better predictive power than the AJCC seventh staging system, which had a potential value of the clinical application.
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Affiliation(s)
- Xiaoyun Cheng
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Gut Microbiota Translational Medicine Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinzhang Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Tianming Xu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Gut Microbiota Translational Medicine Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kemin Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Gut Microbiota Translational Medicine Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Gut Microbiota Translational Medicine Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wang Y, Zhang Y, Lin H, Xu M, Zhou X, Zhuang J, Yang Y, Chen B, Liu X, Guan G. Risk factors for lymph node metastasis in rectal neuroendocrine tumors: A recursive partitioning analysis based on multicenter data. J Surg Oncol 2021; 124:1098-1105. [PMID: 34291822 DOI: 10.1002/jso.26615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/22/2021] [Accepted: 07/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The well-differentiated rectal neuroendocrine tumors (RNETs) can also have lymph node metastasis (LNM). Large multicenter data were reviewed to explore the risk factors for LNM in RNETs. Further, we developed a model to predict the risk of LNM in RNETs. METHODS In total, 223 patients with RNETs from the Fujian Medical University Union Hospital, the First Affiliated Hospital of Fujian Medical University, and the First Affiliated Hospital of Xiamen University were retrospectively enrolled. Logistic regression analysis was performed to study the factors affecting LNM, and recursive partitioning analysis (RPA) was performed to stratify the risk of LNM. RESULTS Among the 223 patients diagnosed with RNETs, the incidence of LNM was 10.8%. Univariate and multivariate regression analyses revealed that tumor size, World Health Organization (WHO) grade, and depth of tumor invasion were independent risk factors for LNM (p < 0.05). The area under the curve was 0.948 (95% confidence interval: 0.890-1.000). Furthermore, the incidence of LNM in patients divided into low- and high-risk groups according to RPA was 1.1% and 56.4%, respectively. CONCLUSION Compared with tumor size, the depth of tumor invasion and WHO grade are more important factors in predicting LNM. Then, we developed a model based on RPA to predict the risk of LNM in RNETs and identify patients who are suitable for local resection.
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Affiliation(s)
- Ye Wang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yiyi Zhang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hexin Lin
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Meifang Xu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin Zhou
- Departments of Colorectal Cancer Surgery, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Jinfu Zhuang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuanfeng Yang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bin Chen
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xing Liu
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guoxian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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Zhou Z, Wang Z, Zhang B, Wu Y, Li G, Wang Z. Comparison of 68Ga-DOTANOC and 18F-FDG PET-CT Scans in the Evaluation of Primary Tumors and Lymph Node Metastasis in Patients With Rectal Neuroendocrine Tumors. Front Endocrinol (Lausanne) 2021; 12:727327. [PMID: 34539577 PMCID: PMC8440966 DOI: 10.3389/fendo.2021.727327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lymph node metastasis of rectal neuroendocrine tumors (RNETs) predicts poor prognosis. However, the assessment of lymph node metastasis remains a challenge. It has been reported that 68Ga-DOTANOC and 18F-FDG PET-CT scans could be employed in the work-up of rectal neuroendocrine tumors (RNETs). This study aimed to assess both tracers' ability to identify primary tumors and lymph node (LN) metastasis in RNETs. METHODS A total of 537 patients with RNETs were enrolled from January 2014 to January 2021. Both 68Ga-DOTANOC and 18F-FDG PET-CT scans were used to evaluate primary tumors and LN group metastasis. PET images were evaluated through visual and semiquantitative assessment. Receiver Operating Characteristics (ROC) curve analysis was used to investigate the performance of SUVmax of 68Ga-DOTANOC and 18F-FDG PET in predicting LN group metastasis. RESULTS Fifty-two patients with preoperative 68Ga-DOTANOC with 18F-FDG PET-CT scans underwent endoscopic biopsy or dissection of the primary tumor, while 11 patients underwent rectal surgery together with regional LN dissection. For primary tumors, 68Ga-DOTANOC had a sensitivity of 89.58% and a positive predictive value (PPV) of 95.56% through visual assessment, while 18F-FDG PET-CT showed 77.08% sensitivity and 97.37% PPV. For the prediction of LN group metastasis, 68Ga-DOTANOC PET-CT had 77.78% sensitivity and 91.67% specificity, while 18F-FDG PET-CT had 38.89% sensitivity and 100% specificity according to visual assessment. The area under the ROC curves (AUC) for 68Ga-DOTANOC PET/CT was 0.852 (95%CI:0.723-0.981) with an optimal SUVmax cut-off value of 2.25, while the AUC for 18F-FDG PET were 0.664 (95%CI:0.415-0.799) with an optimal SUVmax cut-off value of 1.05. CONCLUSIONS This study showed that 68Ga-DOTANOC PET-CT was a promising tool for detecting LN metastasis in RNETs with high sensitivity and specificity in visual assessment and semiquantitative assessment, which was better than 18F-FDG PET-CT.
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Affiliation(s)
- Zhihao Zhou
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhixiong Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bing Zhang
- Department of Nuclear Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanzhang Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Guanghua Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- *Correspondence: Zhao Wang, ; Guanghua Li,
| | - Zhao Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- *Correspondence: Zhao Wang, ; Guanghua Li,
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Gut P, Waligórska-Stachura J, Czarnywojtek A, Sawicka-Gutaj N, Bączyk M, Ziemnicka K, Woliński K, Zybek A, Fischbach J, Ruchała M. Hindgut neuroendocrine neoplasms - characteristics and prognosis. Arch Med Sci 2017; 13:1427-1432. [PMID: 29181074 PMCID: PMC5701690 DOI: 10.5114/aoms.2017.64979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/18/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to analyze the clinicopathologic characteristics and prognostic factors of hindgut-rectal neuroendocrine neoplasms. MATERIAL AND METHODS The study included 38 patients with rectal neuroendocrine tumors who were treated at the Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland from February 2010 to December 2015. The clinicopathological data were retrospectively reviewed, extracted, analyzed, and patients were followed up to determine their survival status. Follow-up data were available for all 38 patients. Uni- and multivariate Cox regression analyses were performed to determine the prognostic factors significantly associated with overall survival. RESULTS The tumors occurred mostly in the middle and lower rectum, and the most typical symptoms experienced by patients were hematochezia and diarrhea. The median distance between the tumors and the anal edges was 4.7 ±1.3 cm, and the median diameter of the tumors was 0.9 ±1.2 cm. The major pathological types were neuroendocrine neoplasm G1 in 31 patients, and neuroendocrine neoplasm G2 in 7 patients. Tumor-node-metastasis (TNM) stages I, II, III and IV tumors accounted for 76.3% (29/38), 5.3% (2/38), 7.9% (3/38) and 10.5% (4/38) of patients, respectively. The main treatment method was transanal extended excision or endoscopic resection. The 1-, 3- and 5-year survival rates of the whole group of patients were 100%, 83.7%, and 75.3%, respectively. CONCLUSIONS Univariate analysis showed that age (p = 0.022), tumor diameter (p < 0.001), histological type (p < 0.001), and TNM stage (p < 0.001) were all prognostic factors.
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Affiliation(s)
- Paweł Gut
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Agata Czarnywojtek
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Nadia Sawicka-Gutaj
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Bączyk
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Ziemnicka
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kosma Woliński
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ariadna Zybek
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jakub Fischbach
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
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Abstract
OBJECTIVE Endoscopic mucosal resection (EMR), including conventional EMR (c-EMR) and modified EMR (m-EMR), was applied to remove small rectal neuroendocrine tumors (NETs). We aim to evaluate treatment outcomes of endoscopic submucosal dissection (ESD), m-EMR and c-EMR for rectal NETs <16 mm. METHODS The PubMed, Cochrane Library and Elsevier Science Direct were searched to identify eligible articles. After quality assessment and data extraction, meta-analysis was performed. The main outcomes were complete resection rate, overall complication rate, procedure time and local recurrence rate. RESULTS Compared with c-EMR, ESD could achieve higher complete resection rate (OR = 4.38, 95%CI: 2.43-7.91, p < 0.00001) without increasing overall complication rates (OR = 2.21, 95%CI: 0.56-8.70, p = 0.25). However, ESD was more time-consuming than c-EMR (MD = 6.72, 95%CI: 5.84-7.60, p < 0.00001). Compared with m-EMR, ESD did not differ from m-EMR in complete resection and overall complication rates (OR = 0.80, 95%CI: 0.51-1.27, p = 0.34; OR = 1.91, 95%CI: 0.75-4.86, p = 0.18, respectively). However, ESD was more time-consuming than m-EMR (MD = 12.21, 95%CI: 7.78-16.64, p < 0.00001). Compared with c-EMR, m-EMR could achieve higher complete resection rate (OR = 4.23, 95%CI: 2.39-7.50, p < 0.00001) without increasing overall complication rate (OR = 1.07, 95%CI: 0.35-3.32, p = 0.90). Moreover, m-EMR was not time-consuming than c-EMR (MD = 2.01, 95%CI: -0.37-4.40, p= 0.10). The local recurrence rate was 0.84% (9/1067) during follow-up. CONCLUSIONS Both ESD and m-EMR have great advantages over c-EMR in complete resection rate without increasing safety concern while m-EMR shares similar outcomes with ESD for rectal NETs <16 mm. The results should be confirmed by well-designed, multicenter, randomized controlled trials with large samples and long-term follow-ups from more countries.
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Affiliation(s)
- Hai-Ping Zhang
- a Department of Gastroenterology , Zhongshan Hospital of Wuhan University , Wuhan City , Hubei Province , China ;,b Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Wei Wu
- b Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Sheng Yang
- b Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
| | - Jun Lin
- a Department of Gastroenterology , Zhongshan Hospital of Wuhan University , Wuhan City , Hubei Province , China ;,b Department of Gastroenterology , Zhongnan Hospital of Wuhan University , Wuhan City , Hubei Province , China
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Kitagawa Y, Ikebe D, Hara T, Kato K, Komatsu T, Kondo F, Azemoto R, Komoda F, Tanaka T, Saito H, Itami M, Yamaguchi T, Suzuki T. Enhanced detection of lymphovascular invasion in small rectal neuroendocrine tumors using D2-40 and Elastica van Gieson immunohistochemical analysis. Cancer Med 2016; 5:3121-3127. [PMID: 27748061 PMCID: PMC5119967 DOI: 10.1002/cam4.935] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 01/30/2023] Open
Abstract
Rectal neuroendocrine tumor (RNET) lymphovascular invasion (LVI) is regarded as an important predictor of nodal metastasis after endoscopic resection (ER). However, little is known about the frequency of immunohistochemical detection of LVI in RNETs. This study was performed to establish the actual detection of LVI rate in RNETs ≤10 mm and to evaluate associated clinical outcomes. We retrospectively reviewed the records for 98 consecutive patients treated by ER with a total of 102 RNETs ≤10 mm. Tissue sections were labeled with hematoxylin–eosin (HE) stain, the D2‐40 monoclonal antibody to evaluate lymphatic invasion, and Elastica van Gieson (EVG) stain to detect venous invasion. LVI detection rate by HE versus immunohistochemical analysis was compared. Follow‐up findings and clinical outcomes were also evaluated for 91 patients who were followed for ≥12 months. Lymphatic and venous invasion were detected using HE staining alone in 6.9% and 3.9% of patients, respectively, whereas they were detected using D2‐40 and EVG staining in 20.6% and 47.1% of the patients, respectively. Thus, the LVI detection frequency using D2‐40 and EVG staining (56.9%) was significantly higher than with HE (8.8%). Two out of seven patients who required additional surgery had regional lymph node metastases. However, among the 84 patients who were followed up without surgery, no distant metastases or recurrences were detected. Compared with HE staining, immunohistochemical analysis significantly increased the frequency of LVI detection in RNETs ≤10 mm. However, the clinical impact of LVIs detected using immunohistochemical analysis remains unclear. Clarification of the actual role of LVI using immunohistochemical analysis requires a patient long‐term follow‐up and outcomes.
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Affiliation(s)
| | - Dai Ikebe
- Division of Surgical Pathology, Chiba Cancer Center, Chiba, Japan
| | - Taro Hara
- Endoscopy Division, Chiba Cancer Center, Chiba, Japan
| | - Kazuki Kato
- Department of Gastroenterology, Funabashi Central Hospital, Funabashi, Japan
| | - Teisuke Komatsu
- Pathology Division, Funabashi Central Hospital, Funabashi, Japan
| | - Fukuo Kondo
- Pathology Division, School of Medicine, Teikyo University, Itabashi, Japan
| | - Ryousaku Azemoto
- Department of Gastroenterology, Kimitsu Chuo Hospital, Kimitsu, Japan
| | - Fumitake Komoda
- Department of Gastroenterology, Chiba Rosai Hospital, Ichihara, Japan
| | - Taketsugu Tanaka
- Department of Gastroenterology, Chiba Rosai Hospital, Ichihara, Japan
| | - Hirofumi Saito
- Department of Gastroenterology, Chiba Kaihin Municipal Hospital, Chiba, Japan
| | - Makiko Itami
- Division of Surgical Pathology, Chiba Cancer Center, Chiba, Japan
| | - Taketo Yamaguchi
- Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Takuto Suzuki
- Endoscopy Division, Chiba Cancer Center, Chiba, Japan
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