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Multicenter Study
. 2023 Sep 22;21(1):300.
doi: 10.1186/s12957-023-03144-0.

Lymph node ratio and hematological parameters predict relapse-free survival in patients with high grade rectal neuroendocrine neoplasms after radical resection: a multicenter prognostic study

Xinyu Zeng #  1 , Peng Zhang #  1 , Guangsheng Zhu #  2 , Chengguo Li  1 , Rui Zhang  3 , Minhao Yu  4 , Guole Lin  5 , Maojun Di  6 , Congqing Jiang  7 , Yong Li  8 , Yueming Sun  9 , Lijian Xia  10 , Pan Chi  11 , Kaixiong Tao  12
Affiliations
Multicenter Study

Lymph node ratio and hematological parameters predict relapse-free survival in patients with high grade rectal neuroendocrine neoplasms after radical resection: a multicenter prognostic study

Xinyu Zeng et al. World J Surg Oncol. .

Abstract

Background: The prognostic nutritional index (PNI), alkaline phosphatase (ALP), and lymph node ratio (LNR) are reportedly related to prognosis. The aim of this study was to elucidate the clinical importance of the LNR and hematological parameters in patients with high grade rectal neuroendocrine neoplasms (HG-RNENs) who were undergoing radical resection.

Methods: We reviewed the medical records of patients with HG-RNENs from 17 large-scale medical centers in China (January 1, 2010-April 30, 2022). A nomogram was constructed by using a proportional hazard model. Bootstrap method was used to draw calibration plots to validate the reproducibility of the model. Concordance index (C-Index), decision curve analysis (DCA), and time-dependent area under the receiver operating characteristic curve (TD-AUC) analysis were used to compare the prognostic predictive power of the new model with American Joint Committee on Cancer (AJCC) TNM staging and European Neuroendocrine Tumor Society (ENETS) TNM staging.

Results: A total of 85 patients with HG-RNENs were enrolled in this study. In the 45 patients with HG-RNENs who underwent radical resection, PNI ≤ 49.13 (HR: 3.997, 95% CI: 1.379-11.581, P = 0.011), ALP > 100.0 U/L (HR: 3.051, 95% CI: 1.011-9.205, P = 0.048), and LNR > 0.40 (HR: 6.639, 95% CI: 2.224-19.817, P = 0.0007) were independent predictors of relapse-free survival. The calibration plots suggested that the nomogram constructed based on the three aforementioned factors had good reproducibility. The novel nomogram revealed a C-index superior to AJCC TNM staging (0.782 vs 0.712) and ENETS TNM staging (0.782 vs 0.657). Also, the new model performed better compared to AJCC TNM staging and ENETS TNM staging in DCA and TD-AUC analyses.

Conclusions: LNR, ALP, and PNI were independent prognostic factors in patients with HG-RNENs after radical resection, and the combined indicator had better predictive efficacy compared with AJCC TNM staging and ENETS TNM staging.

Keywords: Carcinoma; Neuroendocrine; Nomograms; Rectal neoplasms; Recurrence.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection flowchart
Fig. 2
Fig. 2
a Cancer specific survival for the whole group. b Relapse-free survival stratified by PNI. c Relapse-free survival stratified by ALP. d Relapse-free survival stratified by LNR
Fig. 3
Fig. 3
Nomogram
Fig. 4
Fig. 4
a Calibration plot of 1-year relapse-free survival. b Calibration plot of 2-year relapse-free survival. c Calibration plot of 3-year relapse-free survival. d The decision curve analysis (DCA)
Fig. 5
Fig. 5
Time-dependent area under the receiver operating characteristic curve (TD-AUC) analysis for relapse-free survival
See this image and copyright information in PMC

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References

    1. Wei G, Feng X, Wang W, Zhang Y, Zeng Y, Chen M, Chen Y, Chen J, Zhou Z, Li Y. Analysis of risk factors of lymph node metastasis in rectal neuroendocrine neoplasms using multicenter data. Future Oncol. 2018;14(18):1817–1823. doi: 10.2217/fon-2018-0059. - DOI - PubMed
    1. Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, Shih T, Yao JC. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017;3(10):1335–1342. doi: 10.1001/jamaoncol.2017.0589. - DOI - PMC - PubMed
    1. Liu M, Wei L, Liu W, Chen S, Guan M, Zhang Y, Guo Z, Liu R, Xie P. Trends in incidence and survival in patients with gastrointestinal neuroendocrine tumors: a SEER database analysis, 1977–2016. Front Oncol. 2023;13:1079575. doi: 10.3389/fonc.2023.1079575. - DOI - PMC - PubMed
    1. Rindi G, Arnold R, Bosman F, et al. WHO classification of tumours of the digestive system. 4. Lyon: International Agency for Research on Cancer (IARC); 2010.
    1. Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J. Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China. Chin J Cancer. 2017;36(1):51. doi: 10.1186/s40880-017-0218-3. - DOI - PMC - PubMed

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