Broecker Justine S, Ethun Cecilia G, Postlewait Lauren M, Le Nina, McInnis Mia, Russell Maria C, Sullivan Patrick, Kooby David A, Staley Charles A, Maithel Shishir K, Cardona Kenneth
Emory University School of Medicine, Atlanta, Georgia, USA.
Am Surg. 2018 May 1;84(5):717-726.
Colon and rectal neuroendocrine tumors (NETs) are often studied as one entity. Recent evidence suggests that worse outcomes are associated with colon compared with rectal NETs; direct comparisons are lacking. Our aim was to assess clinicopathologic, treatment, and survival differences between these diseases. All patients who underwent resection of colorectal NETs at one institution from 2000 to 2014 were included and analyzed. Of 29 patients, 12(41%) had colon and 17 (59%) had rectal NETs. Baseline demographics were similar between groups, although colon patients tended to be symptomatic at presentation (67% vs 44%, P = 0.41). Eighty-three per cent of colon patients underwent surgical resection, whereas 77 per cent of rectal patients underwent endoscopic or transanal resection (P = 0.003). Colon patients had larger (3.4 cm vs 0.7 cm, P = 0.03), higher T-stage (T3/T4: 91% vs 14%, P = 0.003), higher grade tumors (42% vs 12%, P = 0.09) with more lymph nodes (58% vs 24%, P = 0.12) and lymphovascular invasion positivity (58% vs 24%, P = 0.32). Five-year disease-specific survival was 53% versus 80 per cent for colon and rectal patients, respectively (P = 0.22). After excluding high-grade tumors, colon NETs were associated with lymphovascular invasion positivity (100% vs 17%, P = 0.05) and advanced T-stage (80% vs 8%, P = 0.01). Colon and rectal 5-year disease-specific survival was 67 versus 80 per cent (P = 0.86). Colon and rectal NETs clinically seem to be distinct entities. Colon tumors have more aggressive clinicopathologic features, which may translate to worse outcomes. These differences in tumor biology may demand distinct management and should be further studied in a multi-institutional setting.
结肠和直肠神经内分泌肿瘤（NETs）常被作为一个整体进行研究。最近的证据表明，与直肠NETs相比，结肠NETs的预后更差；但缺乏直接比较。我们的目的是评估这些疾病在临床病理、治疗和生存方面的差异。纳入并分析了2000年至2014年在一家机构接受结直肠NETs切除术的所有患者。在29例患者中，12例（41%）患有结肠NETs，17例（59%）患有直肠NETs。两组患者的基线人口统计学特征相似，不过结肠患者在就诊时往往有症状（67%对44%，P = 0.41）。83%的结肠患者接受了手术切除，而77%的直肠患者接受了内镜或经肛门切除（P = 0.0。结肠患者的肿瘤更大（3.4厘米对0.7厘米，P = 0.03），T分期更高（T3/T4：91%对14%，P = 0.003），肿瘤分级更高（42%对12%，P = 0.09），有更多的淋巴结转移（58%对24%，P = 0.12）和淋巴管侵犯阳性（58%对24%，P = 0.32）。结肠和直肠患者的5年疾病特异性生存率分别为53%和80%（P = 0.22）。排除高级别肿瘤后，结肠NETs与淋巴管侵犯阳性（100%对17%，P = 0.05）和晚期T分期（80%对8%，P = 0.01）相关。结肠和直肠的5年疾病特异性生存率分别为67%和80%（P = 0.86）。结肠和直肠NETs在临床上似乎是不同的实体。结肠肿瘤具有更具侵袭性的临床病理特征，这可能导致更差的预后。肿瘤生物学的这些差异可能需要不同的管理方式，应在多机构环境中进一步研究。
