Department of Gastroenteropancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang West Rd. of Guangzhou, Guangzhou City, 510120, People's Republic of China.
J Gastrointest Surg. 2014 May;18(5):968-76. doi: 10.1007/s11605-014-2480-x. Epub 2014 Feb 19.
The phenomenon of neuroendocrine differentiation has been observed in colorectal adenocarcinoma. However, the ability of neuroendocrine differentiation to predict the outcome of colorectal adenocarcinoma remains controversial.
We conducted an extensive search of research studies related to neuroendocrine differentiation using scientific databases, including the PubMed, Embase, OVID, BIOSIS Previews, and Cochrane Central Register of Controlled Trials (up to July, 2013), according to the established search terms. RevMan version 5.2 statistical program was used to analyze the data. An odds ratio (OR) with a 95% confidence interval (CI) was used for the dichotomous data.
Eleven studies with a total of 1,587 patients were included. Patients with neuroendocrine differentiation who underwent a radical operation had a lower 5-year survival rate (pooled OR 0.60, 95% CI 0.37-0.97) compared with those without neuroendocrine differentiation, with evidence of moderate heterogeneity (I (2) = 37%, p = 0.10). A sensitivity analysis and meta-regression showed that the different classification criteria of neuroendocrine differentiation used in these studies were the main source of heterogeneity. When the strong positive rates of neuroendocrine differentiation indicators between the higher (stage III + IV) and the lower (stage I + II) clinical stages were compared, the pooled OR was 1.84 (703 patients; 95% CI 0.98-3.43) without evidence of heterogeneity (I (2) = 0 %, p = 0.89). However, comparisons between consecutive stages showed different ORs: stage II vs. I (203 patients; OR = 0.52, 95% CI 0.17-1.56), stage III vs. II (569 patients; OR = 2.27, 95% CI 1.03-4.98), and stage IV vs. III (375 patients; OR = 1.81, 95% CI 1.00-3.29).
The patients with strong positive indicators of neuroendocrine differentiation had a lower 5-year survival rate. The ability to detect neuroendocrine indicators using conventional methods could improve the prognosis judgment of colorectal adenocarcinoma.
神经内分泌分化现象已在结直肠腺癌中观察到。然而，神经内分泌分化预测结直肠腺癌结局的能力仍存在争议。
我们根据既定的检索词，利用科学数据库（包括 PubMed、Embase、OVID、BIOSIS Previews 和 Cochrane 对照试验中心注册库）广泛检索与神经内分泌分化相关的研究文献。采用 RevMan 版本 5.2 统计程序对数据进行分析。二项数据采用比值比（OR）及其 95%置信区间（CI）表示。
共纳入 11 项研究，总计 1587 例患者。接受根治性手术的伴有神经内分泌分化的患者 5 年生存率较低（合并 OR 0.60，95% CI 0.37-0.97），存在中度异质性（I ² = 37%，p = 0.10）。敏感性分析和亚组分析显示，这些研究中使用的不同神经内分泌分化分类标准是异质性的主要来源。当比较较高（Ⅲ+Ⅳ期）和较低（Ⅰ+Ⅱ期）临床分期之间神经内分泌分化指标的强阳性率时，合并 OR 为 1.84（703 例患者；95% CI 0.98-3.43），无明显异质性（I ² = 0%，p = 0.89）。然而，连续分期之间的比较显示出不同的 OR：Ⅱ期 vs. Ⅰ期（203 例患者；OR = 0.52，95% CI 0.17-1.56），Ⅲ期 vs. Ⅱ期（569 例患者；OR = 2.27，95% CI 1.03-4.98），以及Ⅳ期 vs. Ⅲ期（375 例患者；OR = 1.81，95% CI 1.00-3.29）。
强阳性神经内分泌分化指标患者的 5 年生存率较低。采用常规方法检测神经内分泌指标可能会改善结直肠腺癌的预后判断。
