Outcomes for a Large Cohort of Patients with Rectal Neuroendocrine Tumors: an Analysis of the National Cancer
Beiqun Zhao1, Hannah M Hollandsworth1, Nicole E Lopez1
1Department of Surgery, Division of Colon and Rectal Surgery, University of California, San Diego, John and Rebecca Moores Cancer Center, 3855 Health Sciences Dr. #0987, La Jolla, CA, 92037, USA.
Background:
Rectal neuroendocrine tumors comprise 20% of neuroendocrine tumors in the alimentary tract, but there is controversy surrounding the optimal management of this disease. The purpose of this study is to better define treatment for patients with rectal neuroendocrine tumors.
Methods:
Using the National Cancer Database, we analyzed patients with rectal neuroendocrine tumors between 2004 and 2015. Patients with metastatic disease and missing treatment data were excluded. We examined overall survival stratified by tumor size, treatment type, and presence of positive lymph nodes using Kaplan-Meier analysis with log-rank test. Cox proportional hazard regression model was performed to identify factors associated with overall survival.
Results:
In total, 17,448 patients with rectal neuroendocrine tumors were identified; 16,531 of these patients met inclusion criteria. The majority of patients had tumors ≤ 10 mm (9216 patients, 79.8%), and approximately 90% underwent local excision. The probability of 5-year overall survival was significantly higher for patients with smaller tumors (≤ 10 mm: 94.1% 11-20 mm: 85.7%, > 20 mm: 71.8%; p < 0.001) and those with no positive lymph nodes (91.4% versus 53.3%, p < 0.001). The probability of 5-year overall survival differed based on treatment modality (local excision: 93.6%, radical resection: 79.1%, observation alone: 77.1%; p < 0.001). On multivariable Cox regression, when compared to local excision, radical resection was not associated with a difference in overall survival but observation alone was associated with significantly worse OS (HR = 2.750, p < 0.001).
Conclusions:
There is a significant difference in overall survival between patients who underwent local excision versus observation alone. Excision of the tumor should be offered to all patients with rectal neuroendocrine tumors who are appropriate surgical candidates, regardless of the tumor size.
Insights
Local excision offers better survival for rectal neuroendocrine tumors compared to observation alone. Surgical candidates should be considered for tumor excision, irrespective of size, to improve outcomes.
Area of Science:
- Gastroenterology and oncology
- Surgical oncology
- Clinical research
Background:
- Rectal neuroendocrine tumors (NETs) represent 20% of gastrointestinal NETs.
- Optimal management strategies for rectal NETs remain debated.
- This study aims to clarify treatment guidelines for rectal NETs.
Purpose of the Study:
- To define optimal treatment strategies for patients diagnosed with rectal neuroendocrine tumors.
- To analyze survival outcomes based on tumor characteristics and treatment modalities.
- To provide evidence-based recommendations for rectal NET management.
Main Methods:
- Analysis of the National Cancer Database (2004-2015) for rectal NET patients.
- Exclusion of patients with metastatic disease or incomplete treatment data.
- Kaplan-Meier analysis and Cox regression to assess overall survival factors.
Main Results:
- Smaller tumors (≤10 mm) and absence of positive lymph nodes correlated with significantly higher 5-year overall survival.
- Local excision (93.6% 5-year OS) demonstrated superior survival compared to radical resection (79.1%) and observation alone (77.1%).
- Multivariable analysis indicated observation alone was linked to significantly worse survival (HR=2.750) versus local excision.
Conclusions:
- A significant survival benefit exists for patients treated with local excision over observation alone.
- Surgical excision should be recommended for all eligible rectal neuroendocrine tumor patients.
- Tumor size should not be a deterrent for surgical intervention in appropriate candidates.
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