Effects of tumor distance from anal verge on survival outcomes for rectal NENs and lymphatic metastasis risk score for colorectal NENs

Abstract

Objective

To explore whether the distance of rectal neuroendocrine neoplasms from the anal margin has an impact on the prognosis of patients and evaluate lymphatic metastases risk score for colorectal neuroendocrine neoplasms (NENs).

Methods

Clinical pathological and follow-up data of 71 patients identified as colorectal neuroendocrine neoplasms by pathology from July 2011 to July 2019 were carefully collected.

Results

Among 71 patients with colorectal NENs, most of the tumors were rectal NENs (62 cases). A total of 26 patients were in the presence of lymph node metastasis, and 44 patients had negative lymph nodes. Patients with lesions from the anal margin > 5 cm in rectum have a better prognosis (P = 0.022). Tumor stage (P = 0.034) and grade (P = 0.001) were independent risk predictors of lymphatic metastases. We developed a lymphatic metastasis risk score for rectal NENs, and patients with the score ≥ 7.5 were more likely to develop lymph node metastases (area 0.958, 95% CI 0.903–1.000, P = 0.000) with a sensitivity of 72.2% and a specificity of 97.3%.

Conclusion

Patients with lesions from the anal margin > 5 cm and lymphatic metastasis risk score ≥ 7.5 should be treated actively.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

References

  1. 1.

    (2016) Expert consensus on gastrointestinal and pancreatic neuroendocrine tumors in China. J Clin Oncol 21(10):927–946

  2. 2.

    Kang H, O’Connell JB, Leonardi MJ, O'Connell JB, Leonardi MJ, Maggard MA, McGory M, Ko CY (2007) Rare tumors of the colon and rectum: a national review. Int J Color Dis 22:183–189

    Article  Google Scholar 

  3. 3.

    Tsikitis VL, Wertheim BC, Guerrero MA et al (2012) Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States: a seer analysis. J Cancer 3:292–302

    Article  Google Scholar 

  4. 4.

    Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, Shih T, Yao JC (2017) Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 3(10):1335–1342

    Article  Google Scholar 

  5. 5.

    Tsai HJ, Wu CC, Tsai CR, Lin SF, Chen LT, Chang JS (2013) The epidemiology of neuroendocrine tumors in Taiwan: a nation-wide cancer registry-based study. PLoS One 8(4):e62487

    CAS  Article  Google Scholar 

  6. 6.

    Hauso O, Gustafsson BI, Kidd M, Waldum HL, Drozdov I, Chan AK, Modlin IM (2008) Neuroendocrine tumor epidemiology: contrasting Norway and North America. Cancer. 113(10):2655–2664

    Article  Google Scholar 

  7. 7.

    Fang C, Wang W, Zhang YU et al (2017) Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China. Chin J Cancer 36(1):51

    Article  Google Scholar 

  8. 8.

    Wang YH, Lin Y, Xue L, Wang JH, Chen MH, Chen J (2012) Relationship between clinical characteristics and survival of gastroenteropancreatic neuroendocrine neoplasms: a single-institution analysis (1995–2012) in South China. BMC Endocr Disord 12:30

    Article  Google Scholar 

  9. 9.

    Fan JH, Zhang YQ, Shi SS, Chen YJ, Yuan XH, Jiang LM, Wang SM, Ma L, He YT, Feng CY, Sun XB, Liu Q, Deloso K, Chi Y, Qiao YL (2017) A nation-wide retrospective epidemiological study of gastroenteropancreatic neuroendocrine neoplasms in China. Oncotarget. 8(42):71699–71708

    Article  Google Scholar 

  10. 10.

    Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, Abdalla EK, Fleming JB, Vauthey JN, Rashid A, Evans DB (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35, 825 cases in the United States. J Clin Oncol 26(18):3063–3072

    Article  Google Scholar 

  11. 11.

    Maryański J, Cyran-Chlebicka A, Szczepankiewicz B, Wroński M (2018) Surgical treatment of extra-appendiceal colorectal neuroendocrine tumors. Pol Przegl Chir 90(3):7–12

    Article  Google Scholar 

  12. 12.

    Fields AC, Lu P, Vierra BM, Melnitchouk N (2019) Survival in patients with high-grade colorectal neuroendocrine carcinomas: the role of surgery and chemotherapy. Ann Surg Oncol 26(4):1127–1133

    Article  Google Scholar 

  13. 13.

    Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13, 715 carcinoid tumors. Cancer 97(4):934–959

    Article  Google Scholar 

  14. 14.

    McConnell YJ (2016) Surgical management of rectal carcinoids: trends and outcomes from the surveillance, epidemiology, and end results database (1988 to 2012). Am J Surg 211:877–885

    Article  Google Scholar 

  15. 15.

    Xiao Y, Wu B, Qiu H, Xiong G, Lin G, Zhong G, Hu K, Pan W (2014) Effects of tumor distance from anal verge and types of operations on survival outcomes for low rectal cancer after neoadjuvant chemoradiotherapy. Zhonghua Yi Xue Za Zhi 94(22):1705–1709

    PubMed  Google Scholar 

  16. 16.

    MAS K, Ang CW, Hakeem AR, Scott N, Saunders RN, Botterill I (2017) The impact of tumour distance from the anal verge on clinical management and outcomes in patients having a curative resection for rectal cancer. J Gastrointest Surg 21(12):2056–2065

    Article  Google Scholar 

  17. 17.

    WHO classification of Tumours Editorial Board (2019) Digestive system tumour. WHO Classification of tumour [M], vol 16, 5th edn. WHO, Geneva

    Google Scholar 

  18. 18.

    2019 National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): neuroendocrine and adrenal tumors. Version 1.2019 - March 5, 2019

  19. 19.

    Restivo A et al (2013) Elevated CEA levels and low distance of the tumor from the anal verge are predictors of incomplete response to chemoradiation in patients with rectal cancer. Ann Surg Oncol 20(3):864–871

    Article  Google Scholar 

  20. 20.

    Garland ML, Vather R, Bunkley N, Pearse M, Bissett IP (2014) Clinical tumour size and nodal status predict pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Int J Color Dis 29(3):301–307

    Article  Google Scholar 

  21. 21.

    Bitterman DS, Resende Salgado L, Moore HG, Sanfilippo NJ, Gu P, Hatzaras I, Du KL (2015) Front Oncol 5:286

    Article  Google Scholar 

  22. 22.

    Aytac E, Ozdemir Y, Ozuner G (2014) Long term outcomes of neuroendocrine carcinomas (high-grade neuroendocrine tumors) of the colon, rectum, and anal canal. J Visc Surg 151(1):3–7

    CAS  Article  Google Scholar 

  23. 23.

    Smith JD, Reidy DL, Goodman KA, Shia J, Nash GM (2014) A retrospective review of 126 high-grade neuroendocrine carcinomas of the colon and rectum. Ann Surg Oncol 21(9):2956–2962

    Article  Google Scholar 

  24. 24.

    Murray SE, Lloyd RV, Sippel RS, Chen H (2013) Clinicopathologic characteristics of colonic carcinoid tumors. J Surg Res 184:183–188

    Article  Google Scholar 

  25. 25.

    Shafqat H, Ali S, Salhab M, Olszewski AJ (2015) Survival of patients with neuroendocrine carcinoma of the colon and rectum: a population-based analysis. Dis Colon Rectum 58:294–303

    Article  Google Scholar 

  26. 26.

    Basuroy R, Haji A, Ramage JK, Quaglia A, Srirajaskanthan R (2016) Review article: the investigation and management of rectal neuroendocrine tumours. Aliment Pharmacol Ther 44:332–345

    CAS  Article  Google Scholar 

  27. 27.

    Mandair D, Caplin ME (2012) Colonic and rectal NET’s. Best Pract Res Clin Gastroenterol 26:775–789

    Article  Google Scholar 

  28. 28.

    Yassar M, Kathryn M, David C et al (2014) Regional lymphadenectomy is indicated in the surgical treatment of pancreatic neuroendocrine tumors (PNETs). Ann Surg 259(2):197–203

    Article  Google Scholar 

  29. 29.

    Konishi T, Watanabe T, Kishimoto J, Kotake K, Muto T, Nagawa H, Japanese Society for Cancer of the Colon and Rectum (2007) Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years. Gut. 56:863–868

    Article  Google Scholar 

  30. 30.

    Concors SJ, Sinnamon AJ, Folkert IW, Roses RE (2018) Predictors of metastases in rectal neuroendocrine tumors: results of a national cohort study. Dis Colon Rectum 61(12):1372–1379

    PubMed  Google Scholar 

  31. 31.

    Strosberg J, Nasir A, Coppola D, Wick M, Kvols L (2009) Correlation between grade and prognosis in metastatic gastroenteropancreatic neuroendocrine tumors. Hum Pathol 40:1262–1268

    Article  Google Scholar 

  32. 32.

    Anthony LB, Strosberg JR, Klimstra DS, Maples WJ, O'Dorisio TM, Warner RR, Wiseman GA, Benson AB 3rd, Pommier RF, North American Neuroendocrine Tumor Society (NANETS) (2010) The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (nets): well differentiated nets of the distal colon and rectum. Pancreas. 39(6):767–774

    Article  Google Scholar 

  33. 33.

    Fields AC, McCarty JC, Ma-Pak L, Melnitchouk N (2019) New lymph node staging for rectal neuroendocrine tumors. J Surg Oncol 119(1):156–162

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding authors

Correspondence to Jinsheng Xu or Fei Yin.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Duan, X., Zhao, M., Zhang, S. et al. Effects of tumor distance from anal verge on survival outcomes for rectal NENs and lymphatic metastasis risk score for colorectal NENs. Int J Colorectal Dis 35, 1255–1264 (2020). https://doi.org/10.1007/s00384-020-03596-w

Download citation

Keywords

  • Colorectal neuroendocrine neoplasms
  • Clinicopathologic features
  • Distance from anal verge
  • Lymphatic metastasis
  • Prognosis