Jianguo Xu, Jian Shi, Yu Mu, Nan Zhou, Yechao Du, Weiwei Lai, Zhaoyong Wang, Lina Zhang, Zhongyan Chen, Qian Ma, Yong-Ping Yang
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引用次数: 0
Abstract
Background: Multiple rectal neuroendocrine tumors (RM-NETs) are a rare and underrecognized subtype of rectal neuroendocrine neoplasms. Although these tumors are usually small and well differentiated, their risk of lymph node metastasis (LNM) may be underestimated when tumor size is considered alone. Current guidelines do not distinguish RM-NETs from solitary lesions. This study investigated the association between tumor count and LNM in patients with RM-NETs.
Methods: A comprehensive literature search of PubMed, Embase, Web of Science, and Scopus was performed from database inception to September 30, 2025. Published case reports and case series describing two or more histologically confirmed rectal NETs were screened for eligibility, and one additional institutional case was included. Individual-level clinicopathological data were extracted and pooled. Receiver operating characteristic analysis was used to explore the discriminative ability of tumor count for LNM, and exploratory multivariable logistic regression was performed to identify factors associated with LNM.
Results: A total of 46 patients were included, comprising 45 patients from 17 published studies and one institutional case. The median age was 57 years, and 80.4% of patients were male. Most tumors measured ≤ 10 mm (91.3%). LNM was identified in 8 patients (17.4%). ROC analysis suggested an exploratory threshold of approximately seven lesions. Patients with ≥ 7 tumors had a significantly higher incidence of LNM than those with fewer than 7 tumors, with rates of 46.7% and 3.2%, respectively. In exploratory multivariable analysis, tumor count ≥ 7 remained associated with LNM.
Conclusions: Tumor count may help identify patients with RM-NETs who are at increased risk of LNM. In this pooled analysis, the exploratory threshold of approximately seven lesions should be regarded as hypothesis-generating rather than as a definitive clinical cutoff. In patients with extensive multifocal disease, this finding may warrant closer nodal staging and multidisciplinary discussion, even when the maximum lesion size is small. Further validation in larger multicenter cohorts is warranted.
背景：多发性直肠神经内分泌肿瘤（RM-NETs）是一种罕见且未被充分认识的直肠神经内分泌肿瘤亚型。虽然这些肿瘤通常很小且分化良好，但当单独考虑肿瘤大小时，其淋巴结转移（LNM）的风险可能被低估。目前的指南没有区分RM-NETs和孤立性病变。本研究探讨了RM-NETs患者肿瘤计数与LNM之间的关系。方法：综合检索PubMed、Embase、Web of Science、Scopus等数据库自建库至2025年9月30日的文献。对两例或两例以上经组织学证实的直肠NETs发表的病例报告和病例系列进行了资格筛选，并纳入了另外一例机构病例。提取并汇总个人水平的临床病理资料。采用受试者工作特征分析来探讨肿瘤计数对LNM的判别能力，并采用探索性多变量logistic回归来确定与LNM相关的因素。结果：共纳入46例患者，包括来自17项已发表研究的45例患者和1例机构病例。中位年龄57岁，80.4%的患者为男性。大多数肿瘤≤10 mm（91.3%）。LNM 8例（17.4%）。ROC分析显示，探查阈值约为7个病灶。≥7个肿瘤的患者LNM发生率明显高于小于7个肿瘤的患者，分别为46.7%和3.2%。在探索性多变量分析中，肿瘤计数≥7仍然与LNM相关。结论：肿瘤计数可能有助于识别有LNM风险增加的RM-NETs患者。在这个汇总分析中，大约7个病变的探索性阈值应该被视为假设产生，而不是作为一个明确的临床截止点。在广泛的多灶性疾病患者中，即使最大病变很小，这一发现也可能需要更紧密的淋巴结分期和多学科讨论。需要在更大的多中心队列中进一步验证。试验注册：不适用。
期刊介绍：
World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics.
Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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