Background/Objectives: Neuroendocrine neoplasms (NENs) of the rectum (rNEN) are a rare and heterogeneous group of tumors that can vary greatly in their biological behavior, from benign to highly aggressive. While small and well-differentiated tumors can often be handled endoscopically and still face a very good prognosis, tumor size, and grade, as well as lymph node and distant metastasis, are known risk factors for impaired prognosis. This study aimed at the identification of further prognostic factors in rNEN. Methods: A retrospective analysis of patients treated for rNEN at the ENTES Center of Excellence at Charité—Universitätsmedizin, including n = 121 patients, was performed to identify risk factors for recurrence, progression, and impaired outcome. Results: Progression-free survival (PFS) and overall survival (OS) differed significantly according to tumor grade (p< 0.001). In rNET patients undergoing surgery, the Ki-67 index and distant metastases were independent risk factors for shorter PFS. Among stage I rNETs, 10 patients developed disease recurrence, associated with lymphatic invasion (1.9% vs. 30.0%,p= 0.008) and higher Ki-67 values (2 (1–6) vs. 2 (1–16),p= 0.054). Conclusions: Tumor grade and presence of metastases represent important predictive factors in rNEN. Notably, even small, early-stage rNETs can harbor a risk of recurrence when unfavorable pathological features are present, highlighting the importance of tailored, risk-adapted surveillance strategies to optimize patient outcomes.
背景/目的：直肠神经内分泌肿瘤（rNEN）是一类罕见且异质性强的肿瘤，其生物学行为差异显著，可从良性到高度侵袭性不等。虽然体积小、分化良好的肿瘤通常可通过内镜处理且预后良好，但肿瘤大小、分级以及淋巴结和远处转移是已知的预后不良风险因素。本研究旨在识别rNEN的其他预后因素。方法：对在Charité—Universitätsmedizin医院ENTES卓越中心接受治疗的121例rNEN患者进行回顾性分析，以确定复发、进展和不良结局的风险因素。结果：无进展生存期（PFS）和总生存期（OS）在不同肿瘤分级间存在显著差异（p<0.001）。在接受手术的rNET患者中，Ki-67指数和远处转移是PFS缩短的独立风险因素。在I期rNET患者中，有10例出现疾病复发，与淋巴侵犯（1.9% vs. 30.0%，p=0.008）和较高的Ki-67值（2（1–6） vs. 2（1–16），p=0.054）相关。结论：肿瘤分级和转移的存在是rNEN的重要预测因素。值得注意的是，即使体积小、处于早期的rNET，若存在不利的病理特征，仍可能具有复发风险，这凸显了制定个体化、基于风险的监测策略以优化患者预后的重要性。
Prognostic Factors in Neuroendocrine Neoplasms of the Rectum
肿瘤(癌症)患者之家