Abstract:
Objective To explore the metastasis rate and related risk factors of T1 stage colonic neuroendocrine tumor (C-NET), and to compare the long-term survival outcomes of patients with non-metastatic (T1N0M0 stage) C-NET after local excision (LE) or radical surgery (RS).
Methods Clinical information of 433 patients diagnosed with C-NET in the SEER database from January 1, 2004 to December 31, 2015 were analyzed. Cox regression was used to analyze the influencing factors of metastasis of C-NET. The patients without metastasis were divided into LE group and RS group, and assigned in a 1∶1 ratio using propensity score matching (PSM) according to gender, age, tumor largest diameter, and infiltration depth, with a caliper value set to 0.02. Kaplan-Meier survival curve was used to analyze 5-year cancer-specific survival (CSS) and overall survival (OS) of patients. Cox regression analysis was used to evaluate the influence of metastasis on survival.
Results Among 419 C-NET patients, 19(4.52%) had distant metastases. Cox regression analysis showed that 11-20 mm of tumor large diameter (HR=9.264, 95%CI 3.322-25.835, P < 0.001), right colon location (HR=0.116, 95%CI 0.042-0.321, P < 0.001), and submucosal invasion (HR=5.842, 95%CI 1.858-18.371, P=0.003) were independent risk factors for distant metastasis of T1 stage C-NET. The 5-year OS rates of non-metastatic and metastatic patients were 94.5% and 47.4%, respectively (χ2=79.762, P < 0.001), and their 5-year CSS rates were 99.5% and 55.7%, respectively (χ2=164.604, P < 0.001). Before PSM, the 5-year OS rates of non-metastatic C-NET patients after LE and RS were 95.8% and 90.1% (χ2=2.679, P=0.063), and the 5-year CSS rates were 100.0% and 97.2% (χ2=0.579, P=0.038); after PSM, the 5-year OS rates of non-metastatic patients after LE and RS were 96.8% and 92.1% (χ2=3.606, P=0.058), and the 5-year CSS rates were 100.0% and 98.5% (χ2=1.015, P=0.314). After PSM, there was no significant difference in the 5-year OS and CSS of patients with defferent tumor location, tumor large diameter, or submucosal invasion between the LE and RS groups.
Conclusions 11-20 mm of tumor diameter, right colon location, and submucosal invasion might be independent risk factors for distant metastasis of T1 stage C-NET, and LE could be an appropriate treatment option for non-metastatic C-NET.