A novel preoperative risk score to predict lymph node positivity for rectal neuroendocrine tumors: An NCDB analysis to guide operative technique

• Type of Material: Article
• Authors: Adriana C. Gamboa, Emory University; Yuan Liu, Emory University; Rachel M. Lee, Emory University; Mohammad Y. Zaidi, Emory University; Charles Staley, Emory University; Maria Russell, Emory University; Kenneth Cardona, Emory University; Patrick Sullivan, Emory University; Shishir Maithel, Emory University
• Language: English
• Date: 2019-08-26
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.25679
• Title of Journal or Parent Work: JOURNAL OF SURGICAL ONCOLOGY
• Volume: 120
• Issue: 6
• Start Page: 932
• End Page: 939
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The data used in the study are derived from a de‐identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.; National Center for Advancing Translational Sciences, Grant/Award Number: UL1TR002378/TL1TR002382
• Keywords: ANASTOMOTIC LEAK; ABDOMINOPERINEAL RESECTION; rectal neuroendocrine tumor; low anterior resection; CARCINOID-TUMORS; Life Sciences & Biomedicine; CONSENSUS-GUIDELINES; DIAGNOSIS; LOW ANTERIOR RESECTION; CANCER; Surgery; lymph node metastasis; ENDOLUMINAL ULTRASOUND; SURGICAL-MANAGEMENT; Oncology; Science & Technology; endoscopic resection; COLON; endoscopic ultrasound

Abstract

Background/Objective: Staging and type of resection for rectal neuroendocrine tumors (R-NETS) relies on preoperative identification of lymph node (LN) involvement. Study objective was to develop a Preoperative Rectal Stratification Score (PReSS) for LN-positivity and to assess the association of PReSS with overall survival (OS). Methods: All patients in the National Cancer Database (2004-2014) with non-metastatic/nonfunctional R-NETS were included. Tumor size was divided into three categories (<1, 1-2, and ≥2 cm). Results: Among 383 patients, median age was 57 years, 52% were male (n = 200), median tumor size was 1.4 cm, 43% had positive LNs (n = 163). On univariate analysis, age > 60, poorly differentiated grade, depth of invasion past submucosa, and size >1 cm were associated with LN positivity. On multivariable analysis, depth of invasion past submucosa, and increasing tumor size >1 cm remained associated with LN positivity. As these can be determined preoperatively, incidence of LN positivity was determined for each combination of tumor size and depth of invasion. Each variable was assigned a score to create a PReSS of four groups (0-3) associated with an increasing rate of LN-positivity (PReSS group 0: 11%, 1: 38%, 2: 50%, 3: 78%, P <.01). PReSS correlated with 10-year OS (PReSS 0: 90%; 1: 81%; 2: 59%; 3: 41%). Conclusion: For R-NETS, depth of invasion and tumor size predict LN positivity and both can be obtained preoperatively. PReSS incorporates both variables and stratifies tumors into four risk groups of progressively increasing LN positivity and should be used to guide surgical approach.