Endoscopy 2021; 53(07): 702-709
DOI: 10.1055/a-1274-0161
Original article

Development of a novel scoring system based on endoscopic appearance for management of rectal neuroendocrine tumors

Luohai Chen*
1  Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
,
Yu Guo*
1  Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
,
Yixuan Zhang
1  Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
,
Man Liu
1  Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
,
Yu Zhang
1  Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
,
Yuan Lin
2  Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
,
Min-hu Chen
1  Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
,
Jie Chen
1  Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
› Author Affiliations

Abstract

Background The clinical significance of the endoscopic appearance of rectal neuroendocrine tumors (NETs) is poorly understood. We aimed to develop a novel scoring system based on endoscopic appearances to predict endoscopically advanced disease in patients with rectal NETs when initially diagnosed.

Methods Patients diagnosed with well-differentiated rectal NETs between January 2005 and December 2019 were retrospectively included. Logistic regression analyses were applied to study the relationship between endoscopic appearance and advanced disease. The whole dataset was randomly divided into training and validation sets, which were used to develop and validate a novel scoring system, respectively.

Results 309 patients were included. The endoscopic appearance of rectal NETs was significantly associated with advanced disease (P < 0.001). A novel scoring system was developed based on endoscopic appearance, including tumor size, tumor shape, and mucosal surface, using the training set. The area under curve (AUC) of the scoring system to predict advanced disease was 0.953 (95 % confidence interval [CI] 0.915 – 0.991; P < 0.001) and 0.960 (95 %CI 0.905 – 1.000; P < 0.001) in the training and validation sets, respectively. Furthermore, the scoring system was significantly associated with tumor grade. Patients with high scores had significantly worse disease-free and overall survival than patients with low scores (P < 0.001).

Conclusion This novel scoring system based on the endoscopic appearance of the primary tumor can help to accurately identify patients with endoscopically advanced disease who are not suitable for endoscopic resection. In addition, it is of great value in monitoring tumor recurrence and overall survival in patients with rectal NETs.

* Contributed equally to this work.


Supplementary material



Publication History

Received: 09 June 2020

Accepted: 29 September 2020

Publication Date:
29 September 2020 (online)

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