对于直肠神经内分泌瘤的管理方法的比较研究在机构系列中样本容量不足。相对于局部切除和根治切除，观察性治疗的有效性尚未明确定义。我们查询了全国癌症数据库，检索出2004年至2019年之间患有非转移性直肠神经内分泌瘤的患者。使用多变量回归分析来确定与观察性管理相关的因素。使用Cox模型来确定与全因死亡率相关的因素。接受观察性管理的患者进行了1：1：1倾向评分匹配以匹配那些接受根治切除和局部切除的患者的人口统计学特征和共病疾病。使用Kaplan-Meier方法来比较匹配队列的总生存率曲线。共有6,316名患者符合纳入标准。其中，5,211名患者（83%）接受了局部切除，600名患者（9.5%）接受了根治切除，505名患者（8%）接受了观察性管理。在多变量回归分析中，与观察性管理相关的因素包括黑人种族、政府保险和肿瘤大小小于2.0厘米。在Cox模型中，与死亡率相关的因素包括年龄大于65岁、男性、政府保险、共病评分大于0、肿瘤大小大于2厘米和疏松分化组织学。在匹配队列比较中：接受根治切除的患者住院时间较长，再入院率较高，相对于接受局部切除的患者；在1期疾病的患者中，队列之间的总生存率没有差异；在2期和3期疾病的患者中，接受局部切除和根治切除的患者相对于接受观察性管理的患者表现出更高的总生存率。观察性管理对于1期直肠神经内分泌瘤的患者是一个合理的方法。局部切除应该是那些患有2/3期疾病的患者的首选治疗方法。版权所有 © 2023. 由Elsevier公司发布。

Studies comparing approaches to managing rectal neuroendocrine tumors are underpowered by institutional series. The efficacy of expectant management relative to local excision and radical resection is poorly defined.We queried the National Cancer Database to identify patients presenting with non-metastatic rectal neuroendocrine tumors between 2004 and 2019. Multivariable regression was used to identify factors associated with expectant management. Cox modeling was used to identify factors associated with all-cause mortality. Patients undergoing expectant management were 1:1:1 propensity score matched for demographics and comorbid disease to those undergoing radical resection and local excision. The Kaplan-Meier method was used to compare overall survival profiles for matched cohorts.A total of 6,316 patients met the inclusion criteria. Of these, 5,211 (83%) underwent local excision, 600 (9.5%) radical resection, and 505 (8%) expectant management. On multivariable regression, factors associated with expectant management included Black race, government insurance, and tumor size <2.0 centimeters. On Cox modeling, factors associated with mortality included age >65 years, male sex, government insurance, comorbidity score >0, tumor size >2 centimeters, and poorly differentiated histology. On comparison of matched cohorts: patients undergoing radical resection had longer hospitalizations and higher readmission rates than those undergoing local excision; there was no difference in overall survival between cohorts in patients with stage 1 disease; in stage 2 and 3 diseases, patients undergoing local excision and radical resection demonstrated improved rates of overall survival relative to those undergoing expectant management.Expectant management is a reasonable approach for patients with stage 1 rectal neuroendocrine tumors. Local excision should be the preferred treatment option for those presenting with stage 2/3 disease.Copyright © 2023. Published by Elsevier Inc.