Current Management and Predictive Factors of Lymph Node Metastasis of Appendix Neuroendocrine Tumors A National Study from the French Group of Endocrine Tumors (GTE)
Current Management and Predictive Factors of Lymph Node Metastasis of Appendix Neuroendocrine Tumors A National Study from the French Group of Endocrine Tumors (GTE)
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DOI：
10.1097/sla.0000000000002736
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发表时间：
2019-07-01
影响因子：
9
通讯作者：
Walter, Thomas
中科院分区：
文献类型：
--
作者：
Rault-Petit, Berenice;Do Cao, Christine;Walter, Thomas
目的：分析淋巴结累及（LN+）的预测因素。背景：阑尾神经内分泌肿瘤（A-NET）阑尾切除术后附加右半结肠切除术（RHC）并淋巴结切除术（LN）的适应症仍然存在争议，特别是对于1 - 2cm大小的肿瘤。方法：纳入2010年1月以后在法国诊断的所有非转移性A-NET患者的国家研究。结果：共纳入403例患者。a - net包括：阑尾尖端（67%）、阑尾体（24%）或阑尾基部（9%）；肿瘤大小< 1cm（62%）、1 ~ 2cm（30%）或bb0 2cm (8%)；1级（91%）；阑尾系膜受累3mm (5%)；淋巴血管（15%）或神经周围（24%）侵犯；切缘阳性（8%）。根据欧洲神经内分泌肿瘤学会（ENETS）的建议，85名患者（21%）应该接受RHC。ENETS指南与多学科肿瘤委员会对于补充性RHC的一致性为89%。总共有100例（25%）患者接受了RHC合并LN切除术，其中26例为LN+。肿瘤大小（最佳截点为1.95 cm）、淋巴血管和神经周围浸润以及pT分类与LN+相关。在44例因1 - 2cm肿瘤行RHC的患者中，8例（18%）有LN+。在该亚组患者中未发现LN+的预测因素（基底、切除边缘、分级、阑尾系膜、淋巴血管、神经周围受累）。结论：在使用最新的a - net完成性RHC病理标准的最大研究中，四分之一的患者有残留肿瘤。在这种情况下，需要进一步的研究来证明RHC对生存的影响。
Objective: The primary endpoint was to analyze the predictive factors of lymph node involvement (LN+).Background: Indications for additional right hemicolectomy (RHC) with lymph node (LN) resection after appendectomy for appendix neuroendocrine tumor (A-NET) remain controversial, especially for tumors between 1 and 2 cm in size.Methods: National study including all patients with nonmetastatic A-NET diagnosed after January, 2010 in France.Results: In all, 403 patients were included. A-NETs were: within tip (67%), body (24%) or base (9%) of the appendix; tumor size was < 1 cm (62%), 1 to 2 cm(30%), or > 2 cm (8%); grade 1 (91%); mesoappendix involvement 3 mm (5%); lymphovascular (15%) or perineural (24%) invasion; and positive resection margin (8%). According to the European NeuroEndocrine Tumor Society (ENETS) recommendations, 85 patients (21%) should have undergone RHC. The agreement between ENETS guidelines and the multidisciplinary tumor board for complementary RHC was 89%. In all, 100 (25%) patients underwent RHC with LN resection, 26 of whom had LN+. Tumor size (best cut-off at 1.95 cm), lymphovascular and perineural invasion, and pT classifications were associated with LN+. Among the 44 patients who underwent RHC for a tumor of 1 to 2 cm in size, 8 (18%) had LN+. No predictive factor of LN+ (base, resection margins, grade, mesoappendix, lymphovascular, perineural involvement) was found in this subgroup of patients.Conclusions: In the largest study using the latest pathological criteria for completion RHC in A-NET, a quarter of patients had residual tumor. Further studies are warranted to demonstrate the survival impact of RHC in this setting.