【评论】局部切除术对比根治性切除术治疗G2级直肠神经内分泌肿瘤效果的多中心倾向性评分匹配分析研究  

[Comment]Local excision versus radical resection for grade 2 rectal neuroendocrine tumors:a multicenter propensity score-matched analysis

作　　者：陈致奋[1] Chen Zhifen

机构地区：[1]福建医科大学附属协和医院结直肠外科,福建福州350001

出　　处：《结直肠肛门外科》2024年第3期362-363,共2页Journal of Colorectal & Anal Surgery

摘　　要：目的本研究旨在比较局部切除术与根治性切除术治疗G2级直肠神经内分泌肿瘤的肿瘤学结局。方法研究者进行回顾性多中心倾向性评分匹配分析以降低不同研究组别之间的异质性,同时关注不同手术策略的差异。这项研究涉及中国的17个大型医疗中心,纳入144例于2010年1月1日至2022年4月30日经病理确诊为G2级直肠神经内分泌肿瘤的患者。主要观察指标是癌症特异性生存率和无复发生存率,并依此比较不同手术策略的治疗效果。结果在本研究纳入的144例G2级直肠神经内分泌肿瘤患者中,27例患者接受了内镜下切除术,55例患者接受了经肛切除术,50例患者接受了根治性切除术,另有12例患者因为远处转移而接受了姑息性手术或活检。在接受了根治性切除术的50例患者中,有30例(60.0%)经术后病理证实淋巴结转移。预测癌症特异性生存情况的肿瘤直径最佳截断值是1.5 cm。对于肿瘤直径≤1.5 cm的G2级直肠神经内分泌肿瘤患者,局部切除术组和根治性切除术组的癌症特异性生存情况及无复发生存情况相近(P>0.05)。对于肿瘤直径>1.5 cm的G2级直肠神经内分泌肿瘤患者,局部切除术组无复发生存率低于根治性切除术组(P=0.04)。结论G2级直肠神经内分泌肿瘤的淋巴结转移率不容忽视。对于直径≤1.5 cm且没有发生转移的肿瘤,局部切除术是一个可行的选择;对于直径>1.5 cm的肿瘤,根治性切除术更为合适。Background Studies on grade 2 rectal neuroendocrine tumors are limited,and the optimal treatment for these tumors is not well established.Objective We aimed to compare the oncologic results of local excision versus radical resection for the treatment of grade 2 rectal neuroendocrine tumors.Design Retrospective multicenter propensity score-matched study to minimize heterogeneity between groups and focus on the differences between surgery strategies.Settings Seventeen large-scale Chinese medical centers participated in this study.Patients A total of 144 patients with pathologically confirmed grade 2 rectal neuroendocrine tumors were retrospectively analyzed.Main outcome measures Cancer-specific survival and relapse-free survival were assessed to compare surgery strategies.Results A total of 144 patients with grade 2 rectal neuroendocrine tumors were enrolled in this study.Twenty-seven patients underwent endoscopic resection,55 underwent transanal excision,50 underwent radical resection,and 12 underwent palliative surgery or biopsy for distant metastasis.Of the 50 patients who underwent radical resection,30(60.0%)had clinically positive lymph nodes on the basis of the histopathology results.The optimal cutoff value for tumor size to predict cancerspecific survival was 1.5 cm.In patients with grade 2 rectal neuroendocrine tumors of≤1.5 cm size,there were no significant differences in cancer-specific survival and relapse-free survival between local excision and radical resection groups(P>0.05).In patients with grade 2 rectal neuroendocrine tumors of>1.5 cm size,relapse-free survival was significantly lower in the local excision group than in the radical resection group(P=0.04).Limitations The nature of retrospective reviews and a relatively short follow-up period are limitations of this study.Conclusions Grade 2 rectal neuroendocrine tumors have a nonnegligible rate of lymph node metastasis.Local excision is a feasible choice for tumors of≤1.5 cm size without metastasis,whereas radical resection is more beneficial

关 键 词：局部切除术 淋巴结转移 根治性切除术 直肠神经内分泌肿瘤 

分 类 号：R735.3[医药卫生—肿瘤]