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Meta-Analysis
. 2025 Jun;60(6):673-682.
doi: 10.1007/s00535-025-02247-7. Epub 2025 Apr 3.

Prevalence and risk factors for lymph node metastasis in duodenal neuroendocrine tumors: a systematic review and meta-analysis

Yohei Ogata  1 , Waku Hatta  2 , Takeshi Kanno  1 , Yutaka Hatayama  1 , Masahiro Saito  1 , Xiaoyi Jin  1 , Tomoyuki Koike  1 , Akira Imatani  1 , Yuhong Yuan  3 , Atsushi Masamune  1
Affiliations
Meta-Analysis

Prevalence and risk factors for lymph node metastasis in duodenal neuroendocrine tumors: a systematic review and meta-analysis

Yohei Ogata et al. J Gastroenterol. 2025 Jun.

Abstract

Background: Although the status of lymph node metastasis (LNM) is crucial in determining treatment strategy for duodenal neuroendocrine tumors (D-NETs), robust evidence for their potential LNM risk remains lacking. This systematic review aimed to summarize the prevalence and risk factors of LNM in D-NETs.

Methods: This systematic review of electronic databases identified eligible case-control and cohort studies for D-NET resected either endoscopically or surgically, published from 1990 to 2023. The primary outcome was the pooled prevalence of LNM in D-NETs. Secondary outcomes included the pooled prevalence of LNM according to tumor location and functionality, as well as identifying pathological risk factors for LNM. Meta-analysis was performed.

Results: We identified 36 studies that involved 1,396 patients with D-NETs, including 326 with LNM. The pooled prevalence of LNM in D-NETs was 22.7% (95% confidence interval [CI] 17.3-29.2%). The prevalence was high in ampullary/peri-ampullary D-NETs and functional D-NETs (46.8 and 53.3%, respectively), whereas it was low in non-functional, non-ampullary D-NETs (NAD-NETs) (9.5%). Pathological risk factors for LNM in NAD-NETs included tumor size > 10 mm (odds ratio [OR] 7.31 [95% CI 3.28-16.31]), tumor invasion into the muscularis propria or deeper (OR 7.79 [3.65-16.61]), lymphovascular invasion (OR 5.67 [2.29-14.06]), and World Health Organization grading of G2 (OR 2.47 [1.03-5.92]).

Conclusion: Approximately one-fourth of the patients with D-NETs had LNM. Endoscopic resection might be acceptable for non-functional NAD-NETs with diameters of 10 mm or less, but additional surgical resection with lymphadenectomy may be recommended for cases exhibiting pathological risk factors.

Keywords: Duodenal neuroendocrine tumors; Lymph node metastasis; Pathological risk factors.

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Conflict of interest statement

Declarations. Conflict of interest: There is no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of studies identified in the systematic review. ER endoscopic resection, LNM lymph node metastasis, NETs neuroendocrine tumors, PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses, SR surgical resection
Fig. 2
Fig. 2
A forest plot of the meta-analysis of the prevalence of LNM in D-NETs. CI confidence interval, D-NETs duodenum neuroendocrine tumors, LNM lymph node metastasis, UK United Kingdom, US United States
See this image and copyright information in PMC

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