Background and Aims

Prevalence of rectal carcinoids is increasing, partly because of increased colorectal cancer screening. Local excision (endoscopic or transanal excision) is usually performed for small (<1-2 cm) rectal carcinoids, but data on clinical outcomes from large population-based U.S. studies are lacking. The aims of this study were to determine the prevalence of metastasis of resected small rectal carcinoid tumors using a large national cancer database and to evaluate the long-term survival of patients after local resection as compared with radical surgery.

Methods

The Surveillance Epidemiology and End Results database was used to identify 788 patients with rectal T1 carcinoids <2 cm in size. Prevalence of metastases at initial diagnosis and risk factors for metastases were analyzed. Cancer-specific survival (CSS) was calculated.

Results

A total of 727 patients (92.3%) had tumors ≤10 mm in diameter and 61 (7.7%) had tumors 11 to 19 mm. Overall, 12 patients (1.5%) had metastasis at the time of diagnosis with prevalence of 1.1% in lesions ≤10 mm and 6.6% in lesions 11 to 19 mm (P = .01). Survival of patients with T1 rectal carcinoids without metastasis was significantly better than those with metastasis (5-year CSS of 100% vs 78%, P < .001). Of 559 patients with T1N0M0 rectal carcinoids ≤10 mm, 5-year CSS was 100% in both groups who underwent local excision and those who underwent radical surgery.

Conclusions

Larger T1 rectal carcinoid tumors (11-19 mm) have significantly higher risk of lymph node metastases compared with those ≤10 mm. Survival is worse with metastatic disease. Local therapy is adequate for T1N0M0 rectal carcinoids ≤10 mm in size with excellent long-term outcomes.

中文翻译：

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788例T1直肠类癌肿瘤的转移和生存率

背景和目标

直肠类癌的患病率正在增加，部分原因是由于结肠直肠癌筛查的增加。通常对小的（<1-2 cm）直肠类癌进行局部切除（内窥镜或经肛门切除），但是缺乏来自大量基于人群的美国研究的临床结果的数据。这项研究的目的是使用大型国家癌症数据库确定切除的小直肠类癌肿瘤的转移患病率，并评估局部切除术与根治性手术相比的长期生存率。

方法

The Surveillance Epidemiology and End Results database was used to identify 788 patients with rectal T1 carcinoids <2 cm in size. Prevalence of metastases at initial diagnosis and risk factors for metastases were analyzed. Cancer-specific survival (CSS) was calculated.

Results

共有727例（92.3％）肿瘤直径≤10毫米，61例（7.7％）肿瘤直径11到19毫米。总体而言，在诊断时有12例患者（1.5％）发生转移，≤10mm病变的患病率为1.1％，在11至19 mm病变的患病率为6.6％（P  = .01）。无转移的T1直肠类癌患者的生存率明显高于有转移的患者（5年CSS分别为100％和78％，P  <.001）。在559例T1N0M0直肠类癌≤10 mm的患者中，接受局部切除和接受根治性手术的两组的5年CSS率为100％。

结论

与≤10mm的那些相比，较大的T1直肠类癌（11-19 mm）具有更高的淋巴结转移风险。转移性疾病的生存期较差。局部治疗足以治疗尺寸小于10毫米的T1N0M0直肠类癌，并具有长期良好的效果。