Huang Y T, Jia R, Xu Q, Ji S J, Cui H T, Xu J M
Department of Gastrointestinal Oncology, the 307th Hospital of the Chinese People's Liberation Army, Beijing 100071, China.
Zhonghua Zhong Liu Za Zhi. 2019 Feb 23;41(2):146-151. doi: 10.3760/cma.j.issn.0253-3766.2019.02.013.
To explore the survival difference of patients with colon and rectal neuroendocrine neoplasm (NEN) at different stages. We identified 8 679 patients with colorectal NEN diagnosed between 1988 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) registry, including 5 437 rectal NEN and 3 242 colon NEN ( 1 681 cecum NEN ). Survival curve was drawn by Kaplan-Meier method. Prognostic factors were analyzed by univariate analysis and multivariate Cox regression model. The ratio of male patients with colon and rectal NEN was similar to female (=0.095). Rectal NEN patients were younger (<0.001), more highly differentiated (<0.001), and with earlier stage (<0.001). Survival analysis showed that the survival of rectal NEN was superior to that of colon NEN, with 10-year tumor-specific survival rates of 86.8% and 44.8% respectively (<0.001). Multivariate Cox analysis showed that age, gender, marital status, primary tumor site, grade, stage and surgery were independent prognostic factors of colorectal NEN (all <0.01). The most important factor was stage (=3.531), followed by differentiation grade (=1.856). Stratified analysis displayed that the survival of rectal NEN in stage Ⅰ, Ⅱ and Ⅳ were better than those of corresponding stage of colon NEN (all <0.05), but worse in stage Ⅲ (=0.012). While the survival of rectal NEN were significantly better than those of colon NEN within all stages after excluding 1681 cases of cecal NEN (all <0.05). Among the patients with well-differentiated NEN, the survival of rectal NEN in stage Ⅰ, Ⅲ and Ⅳ were better than those of corresponding stage of colon NEN (all <0.05) while there was no significant difference in stage Ⅱ(=0.169). For poor-differentiated NEN, only the survival of rectal NEN patients in stage Ⅳ (=0.001) was significant longer than those of colon NEN, while there was no significant difference in stage Ⅰ, Ⅱ and Ⅲ (stage Ⅰ: =0.760; stage Ⅱ: =0.181; stage Ⅲ: =0.313). The survival of NEN patients in colon and rectum is different. Cecum NEN should be considered as a separated tumor for prognostic analysis due to its special clinicopathologic characteristics.
探讨不同分期的结直肠神经内分泌肿瘤（NEN）患者的生存差异。我们从监测、流行病学和最终结果（SEER）数据库中识别出1988年至2014年间诊断为结直肠NEN的8679例患者，其中包括5437例直肠NEN和3242例结肠NEN（1681例盲肠NEN）。采用Kaplan-Meier法绘制生存曲线。通过单因素分析和多因素Cox回归模型分析预后因素。结直肠NEN男性患者与女性患者的比例相似（=0.095）。直肠NEN患者更年轻（<0.001）、分化程度更高（<0.001）且分期更早（<0.001）。生存分析显示，直肠NEN的生存率优于结肠NEN，10年肿瘤特异性生存率分别为86.8%和44.8%（<0.001）。多因素Cox分析显示，年龄、性别、婚姻状况、原发肿瘤部位、分级、分期和手术是结直肠NEN的独立预后因素（均<0.01）。最重要的因素是分期（=3.531），其次是分化程度（=1.856）。分层分析显示，Ⅰ期、Ⅱ期和Ⅳ期直肠NEN的生存率优于相应分期的结肠NEN（均<0.05），但Ⅲ期除外（=0.012）。在排除1681例盲肠NEN病例后，各分期直肠NEN的生存率均显著优于结肠NEN（均<0.05）。在高分化NEN患者中，Ⅰ期、Ⅲ期和Ⅳ期直肠NEN的生存率优于相应分期的结肠NEN（均<0.05），而Ⅱ期无显著差异（=0.169）。对于低分化NEN，只有Ⅳ期直肠NEN患者的生存率显著长于结肠NEN（=0.001），而Ⅰ期、Ⅱ期和Ⅲ期无显著差异（Ⅰ期：=0.760；Ⅱ期：=0.181；Ⅲ期：=0.313）。结直肠NEN患者的生存情况存在差异。由于其特殊的临床病理特征，盲肠NEN应被视为一种单独的肿瘤进行预后分析。
