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The 5\u2010year survival was set as the end\u2010point. 6675 patients with rectal NETs and 329 patients with rectosigmoid junction NETs, were eligible for the analysis. Initially, the survival analyses suggested that the 5\u2010year survival significantly differed between the patients with rectal and rectosigmoid junction NETs (HR\u00a0=\u00a00.82, 95% CI 0.70\u20100.95; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01). Tumor differentiation, an invasion deeper than T2, and lymph node and distant metastases were still important risk factors affecting survival for both location. While, the males showed better survival (HR\u00a0=\u00a00.69, 95% CI 0.55\u20100.88; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) and primary tumor surgery had no benefits (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.56) for patients with rectosigmoid junction NETs. The factors that predict regional lymph node metastases varied by location. In rectal NETs, invasion deeper than T1 and a tumor larger than 1\u00a0cm could significantly increase the risk of regional lymph node metastases (all OR\u00a0&gt;\u00a05, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01). In rectosigmoid junction NETs, the risk of regional lymph node metastases was considered significantly higher with invasion deeper than T1 (all OR\u00a0&gt;\u00a05, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) and a tumor larger than 2\u00a0cm (OR\u00a0=\u00a031.32, 95% CI 2.53\u2010387.57; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01). We advocate a clear and consistent definition of the rectosigmoid junction for future studies, and more studies are needed to determine the reason underlying differences between rectum and rectosigmoid junction.<\/jats:p>","DOI":"10.1002\/cam4.2779","type":"journal-article","created":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T08:27:30Z","timestamp":1576484850000},"page":"971-979","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Rectal NETs and rectosigmoid junction NETs may need to be treated differently"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8922-9949","authenticated-orcid":false,"given":"Wen","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Gastroenterology The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou Zhejiang China"},{"name":"Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education) The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiting","family":"Ge","sequence":"additional","affiliation":[{"name":"Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education) The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanguang","family":"Hu","sequence":"additional","affiliation":[{"name":"Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education) The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou Zhejiang China"},{"name":"Department of Medical Oncology The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou Zhejiang 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