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Related Experiment Video

Updated: Feb 2, 2026

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New lymph node staging for rectal neuroendocrine tumors.

Adam C Fields1,2, Justin C McCarty3, Linda Ma-Pak1,3

  • 1Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Journal of Surgical Oncology
|November 28, 2018
PubMed
Summary

The number of positive lymph nodes significantly impacts survival for rectal neuroendocrine tumors (NETs). A new staging system (N0, N1, N2) based on lymph node count offers improved prognostic accuracy for rectal NET patients.

Keywords:
AJCC stagingcarcinoid tumorlymph nodesrectal cancerrectal neuroendocrine tumor

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Area of Science:

  • Oncology
  • Gastroenterology
  • Surgical Pathology

Background:

  • Current American Joint Commission on Cancer (AJCC) guidelines for rectal neuroendocrine tumors (NETs) use a simplified N0/N1 nodal staging.
  • This existing system does not differentiate prognosis based on the quantity of positive lymph nodes.
  • There is a need for a more refined nodal staging system for rectal NETs.

Purpose of the Study:

  • To investigate the prognostic impact of the number of positive lymph nodes in patients with rectal neuroendocrine tumors (NETs).
  • To develop and validate a novel nodal staging system for rectal NETs based on lymph node count.

Main Methods:

  • Utilized the National Cancer Database to identify 687 patients with rectal NETs who underwent surgical resection.
  • Employed nearest-neighbor grouping to stratify patients by survival and establish a new nodal staging system.
  • Validated the new staging system using an external dataset.

Main Results:

  • Identified distinct 5-year survival rates for N0 (81.8%), N1 (1-4 positive nodes, 57.8%), and N2 (≥5 positive nodes, 32.6%) groups (P < 0.0001).
  • The novel nodal staging system demonstrated clear survival differences in the external validation set.
  • Multivariable analysis confirmed the new nodal stage as an independent predictor of overall survival.

Conclusions:

  • The quantity of positive locoregional lymph nodes is a critical independent prognostic factor for rectal NETs.
  • The AJCC staging for rectal NETs should be updated to include N0, N1, and N2 categories.
  • This revised staging will enhance survival estimations for patients diagnosed with rectal neuroendocrine tumors.