Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2019 Apr;26(4):1127-1133. doi: 10.1245/s10434-019-07203-3. Epub 2019 Jan 31.
Colorectal neuroendocrine tumors are a rare malignancy, yet their incidence appears to be increasing. The optimal treatment for the high-grade subset of these tumors remains unclear. We aimed to examine the relationship between different treatment modalities and outcomes for patients with high-grade neuroendocrine carcinomas (HGNECs) of the colon and rectum.
The National Cancer Database (2004-2015) was used to identify patients diagnosed with colorectal HGNECs. The primary outcome was overall survival. A Cox Proportional hazard model was used to identify risk factors for survival.
Overall, 1208 patients had HGNECs; 452 (37.4%) patients had primary tumors of the rectum, and 756 (62.5%) patients had primary tumors of the colon. A total of 564 (46.7%) patients presented with stage IV disease. The median survival was 9.0 months [95% confidence interval (CI) 8.2-9.8]. In multivariable analysis, surgical resection [hazard ratio (HR) 0.54, 95% CI 0.44-0.66; p < 0.001], chemotherapy (HR 0.74, 95% CI 0.69-0.79; p < 0.001), and rectum as the primary site of tumor (HR 0.62, 95% CI 0.51-0.76; p < 0.001) were associated with better overall survival, while older age (HR 1.01, 95% CI 1.00-1.01; p = 0.02) and the presence of metastatic disease (HR 3.34, 95% CI 2.69-4.15; p < 0.001) were associated with worse survival.
Patients with colorectal HGNECs selected for chemotherapy and surgical resection of the primary tumor demonstrated better overall survival than those managed without resection. Patients who were able to undergo systemic chemotherapy may benefit from potentially curative resection of the primary tumor.
结直肠神经内分泌肿瘤是一种罕见的恶性肿瘤，但发病率似乎在上升。这些肿瘤中高级别亚组的最佳治疗方法仍不清楚。我们旨在研究不同治疗方式与结直肠高级别神经内分泌癌（HGNEC）患者结局之间的关系。
使用国家癌症数据库（2004-2015 年）确定诊断为结直肠 HGNEC 的患者。主要结局为总生存。采用 Cox 比例风险模型确定生存的危险因素。
共有 1208 例患者患有 HGNEC；452 例（37.4%）患者直肠原发肿瘤，756 例（62.5%）患者结肠原发肿瘤。共有 564 例（46.7%）患者为 IV 期疾病。中位生存时间为 9.0 个月[95%置信区间（CI）8.2-9.8]。多变量分析显示，手术切除[风险比（HR）0.54，95%CI 0.44-0.66；p<0.001]、化疗（HR 0.74，95%CI 0.69-0.79；p<0.001）和肿瘤原发部位在直肠（HR 0.62，95%CI 0.51-0.76；p<0.001）与总生存更好相关，而年龄较大（HR 1.01，95%CI 1.00-1.01；p=0.02）和存在转移疾病（HR 3.34，95%CI 2.69-4.15；p<0.001）与较差的生存相关。
选择化疗和原发肿瘤切除术的结直肠 HGNEC 患者的总生存优于未接受切除术的患者。能够接受全身化疗的患者可能受益于原发肿瘤的潜在治愈性切除。
