摘要Objective The aim of this study was to investigate the risk factors of lymph node metastasis in rectal neuroendocrine neoplasms (RNENs). Methods We enrolled 168 patients with RNENs as the research object, and their clinicopathological and survival data were collected. The risk factors affecting lymph node metastasis were analyzed retrospectively, and independent risk factors affecting prognosis were evaluated. Results Analysis showed that age, tumor diameter, tumor function, grade, and T stage were correlated with lymph node metastasis (P < 0.05). Multiple logistic regression analysis showed that tumor size, grade, and T stage were independent risk factors for lymph node metastasis in patients with RNENs. Kaplan–Meier analysis showed that the 5-year overall survival (OS) of patients with lymph node metastasis was 40.0％ (10/25), and that of patients without lymph node metastasis was 93.0％ (133/143). The prognosis of RNENs patients with lymph node metastasis along with patients with large tumor diameter and high grade was poor. Cox multivariate analysis showed that tumor diameter (HR = 1.985, P = 0.008), grade (HR = 3.416, P = 0.004), T stage (HR = 2.413, P = 0.014), and lymph node metastasis (HR = 3.119, P = 0.000) were independent risk factors affecting the prognosis of patients with RNENs. Conclusion Tumor size, grade, and T stage are the main risk factors for lymph node metastasis and prognosis in patients with RNENs. These risk factors should be fully evaluated before surgery.