Prognostische Faktoren bei lokoregionalen (Stadium I-III) neuroendokrinen Neoplasien des Dünndarms

Ziel der vorliegenden Arbeit war es, Risikofaktoren für das Auftreten eines Rezidivs nach potentiell kurativer Operation an Patienten mit jejunoilealen neuroendokrinen Neoplasien der Stadien I-III zu evaluieren. Patienten wurden in eine prospektive Datenbank eingeschlossen, falls sie zwischen Janua...

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Bibliographic Details
Main Author: Evers, Maximilian Antonius
Contributors: Bartsch, Detlef Klaus (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2022
Online Access:PDF Full Text
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Background Small intestinal neuroendocrine neoplasms (SI-NEN) are rare and only about 40% of patients are diagnosed without distant metastases. Aim of the study was to identify prognostic factors in patients with potentially curative resected locoregional SI-NEN. Methods Patients with curative resected locoregional SI-NEN (ENETS stages I-III) were retrieved from a prospective database. Demographic, surgical and pathological data of patients with and without disease recurrence were retrospectively analyzed using univariate and multivariate analysis. Results In a 20 years period 65 of 203 (32%) patients with SI-NEN were operated for stage I-III disease. Thirty-eight (58.5%) patients were men and the median age at surgery was 59 (range 37-87) years. After median follow-up of 65 months 14 patients experienced disease relapse median 28.5 (range 6-122) months after initial surgery, of which 2 died due to their disease. Multivariate analysis revealed age ≥ 60 years (HR = 6.41, 95%CI 1.38-29.67, p = 0.017), tumor size ≥ 2 cm (HR = 26.54, 95%CI 4.46-157.62, p < 0.001), lymph node ratio > 0.5 (HR 7.18, 95%CI 1.74-29.74, p = 0.007) and multifocal tumor growth (HR = 6.98, 95%CI 1.66-29.39, p = 0.008) as independent negative prognostic factors and right hemicolectomy compared to segmental small bowel resection (HR = 0.04, 95%CI 0.01-0.24, p < 0.001) as independent positive prognostic factors for recurrence. Conclusion Patients with locoregional SI-NEN with an age ≥ 60 years, tumor size ≥ 2cm, lymph node ratio > 0.5 and multiple small bowel tumor foci have an increased risk for recurrence and might benefit from adjuvant treatment. In contrast, right hemicolectomy of ileal SI-NEN seems to reduce the risk of recurrence.