Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 907-918
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.907
Clinical features and prognostic factors of duodenal neuroendocrine tumours: A comparative study of ampullary and nonampullary regions
Sa Fang, Yu-Peng Shi, Lu Wang, Shuang Han, Yong-Quan Shi
Sa Fang, Yu-Peng Shi, Shuang Han, Department of Gastroenterology, Honghui Hospital, Xi’an Jiaotong University, Xi'an 710054, Shanxi Province, China
Lu Wang, Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710032, Shaanxi Province, China
Yong-Quan Shi, Department of Gastroenterology, Xijing Hospital Affiliated to Air Force Medical University, Xi'an 710032, Shaanxi Province, China
Co-first authors: Sa Fang and Yu-Peng Shi.
Co-corresponding authors: Yong-Quan Shi and Shuang Han.
Author contributions: Fang S contributed to data collection, statistical analysis, follow-up visit, writing-original draft, and writing-review and editing; Wang L, Shi YP, Han S and Shi YQ contributed to writing-review and editing.
Institutional review board statement: The study protocol was approved by the Clinical Research Ethics Committee of Honghui Hospital, Xi’an Jiaotong University (No. 202401004).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [email address: hexie19901121@163.com]. Participants gave informed consent for data sharing. No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Quan Shi, PhD, Chief Doctor, Department of Gastroenterology, Xijing Hospital Affiliated to Air Force Medical University, No. 127 Changle East Road, Xincheng District, Xi'an 710032, Shaanxi Province, China. shiyquan@fmmu.edu.cn
Received: December 2, 2023
Peer-review started: December 2, 2023
First decision: December 14, 2023
Revised: January 5, 2024
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: March 15, 2024
Abstract
BACKGROUND

Duodenal neuroendocrine tumours (DNETs) are rare neoplasms. However, the incidence of DNETs has been increasing in recent years, especially as an incidental finding during endoscopic studies. Regrettably, there is no consensus regarding the ideal treatment of DNETs. Even there are few studies on the clinical features and survival analysis of DNETs.

AIM

To analyze the clinical characteristics and prognostic factors of patients with duodenal neuroendocrine tumours.

METHODS

The clinical data of DNETs diagnosed in the First Affiliated Hospital of Air Force Military Medical University from June 2011 to July 2022 were collected. Neuroendocrine tumours located in the ampulla area of the duodenum were divided into the ampullary region group; neuroendocrine tumours in any part of the duodenum outside the ampullary area were divided into the nonampullary region group. Using a retrospective study, the clinical characteristics of the two groups and risk factors affecting the survival of DNET patients were analysed.

RESULTS

Twenty-nine DNET patients were screened. The male to female ratio was 1:1.9, and females comprised the majority. The ampullary region group accounted for 24.1% (7/29), while the nonampullary region group accounted for 75.9% (22/29). When diagnosed, the clinical symptoms of the ampullary region group were mainly abdominal pain (85.7%), while those of the nonampullary region groups were mainly abdominal distension (59.1%). There were differences in the composition of staging of tumours between the two groups (Fisher's exact probability method, P = 0.001), with nonampullary stage II tumours (68.2%) being the main stage (P < 0.05). After the diagnosis of DNETs, the survival rate of the ampullary region group was 14.3% (1/7), which was lower than that of 72.7% (16/22) in the nonampullary region group (Fisher's exact probability method, P = 0.011). The survival time of the ampullary region group was shorter than that of the nonampullary region group (P < 0.000). The median survival time of the ampullary region group was 10.0 months and that of the nonampullary region group was 451.0 months. Multivariate analysis showed that tumours in the ampulla region and no surgical treatment after diagnosis were independent risk factors for the survival of DNET patients (HR = 0.029, 95%CI 0.004-0.199, P < 0.000; HR = 12.609, 95%CI: 2.889-55.037, P = 0.001). Further analysis of nonampullary DNET patients showed that the survival time of patients with a tumour diameter < 2 cm was longer than that of patients with a tumour diameter ≥ 2 cm (t = 7.243, P = 0.048). As of follow-up, 6 patients who died of nonampullary DNETs had a tumour diameter that was ≥ 2 cm, and 3 patients in stage IV had liver metastasis. Patients with a tumour diameter < 2 cm underwent surgical treatment, and all survived after surgery.

CONCLUSION

Surgical treatment is a protective factor for prolonging the survival of DNET patients. Compared to DNETs in the ampullary region, patients in the nonampullary region group had a longer survival period. The liver is the organ most susceptible to distant metastasis of nonampullary DNETs.

Keywords: Duodenum, Neuroendocrine, Tumour, Ampullary, Nonampullary, Clinical features, Prognostic

Core Tip: A retrospective study of the clinical features and prognostic factors of the ampullary and nonampullary of the duodenum neuroendocrine tumours. This study comprehensively analyses the basic characteristics, clinical symptoms, tumour characteristics, histological grading and classification, tumour clinical staging, treatment, and factors affecting the survival prognosis of patients with duodenal neuroendocrine tumours (DNETs). We found that surgical treatment is a protective factor for prolonging the survival of DNET patients. Compared to DNETs in the ampullary region, patients in the nonampullary region had a longer survival period. The liver is the organ most susceptible to distant metastasis of nonampullary DNETs.