Guo Jianping, Zheng Peilin, Wang Ran, Tan Xiangzhou, Yang Weimin, Xiao Shihan, Chen Zhikang
Department of General Surgery, Xiangya Hospital, Central South University, 87th Xiangya Rd, Kaifu District, Changsha, 410000, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Int J Colorectal Dis. 2020 Dec;35(12):2185-2195. doi: 10.1007/s00384-020-03708-6. Epub 2020 Jul 28.
Neuroendocrine differentiation (NED) may serve as a prognostic factor in colorectal cancer; however, the prognostic relevance of NED remains controversial. The aim of the present study was to determine whether NED influenced the survival of patients in colorectal cancer while exploring its potential interactions with other clinicopathological features.
Patients with primary stage I to IV colorectal adenocarcinoma ranging between 2010 and 2015 were identified using the Surveillance, Epidemiology, and End Results database. The Kaplan-Meier technique, Cox proportional hazards model, propensity score matching, and stratification analyses were employed in this study.
A total of 94,291 patients (including 101 patients with NED and 94,190 patients without NED) were included. In the univariable analyses, NED was found to be correlated with a significantly poorer overall survival (hazard ratio (HR) of death = 3.09, 95% CI 2.42-3.95, P < 0.001) and cancer-specific survival (HR of death = 3.77, 95% CI 2.94-4.83, P < 0.001). Moreover, NED remained independently correlated with overall survival (HR of death = 1.84, 95% CI 1.34-2.51, P < 0.001) and cancer-specific survival (HR of death = 2.01, 95% CI 1.45-2.79, P < 0.001) after adjusting in multivariable and propensity score analyses. Furthermore, further stratification analyses indicated that the influence of NED on survival was not affected by tumor location, differentiation, T stage, and distant metastasis status; however, it was found to be associated with lymph node metastasis.
NED is associated with poor survival outcomes among colorectal cancer patients, especially in those with positive lymph nodes.
神经内分泌分化（NED）可能是结直肠癌的一个预后因素；然而，NED的预后相关性仍存在争议。本研究的目的是确定NED是否影响结直肠癌患者的生存，同时探索其与其他临床病理特征的潜在相互作用。
使用监测、流行病学和最终结果数据库识别2010年至2015年间原发性I至IV期结直肠腺癌患者。本研究采用Kaplan-Meier技术、Cox比例风险模型、倾向评分匹配和分层分析。
共纳入94291例患者（包括101例NED患者和94190例非NED患者）。在单变量分析中，发现NED与总体生存率显著较差（死亡风险比（HR）=3.09，95%CI 2.42-3.95，P<0.001）和癌症特异性生存率（死亡HR=3.77，95%CI 2.94-4.83，P<0.001）相关。此外，在多变量和倾向评分分析调整后，NED仍与总体生存率（死亡HR=1.84，95%CI 1.34-2.51，P<0.001）和癌症特异性生存率（死亡HR=2.01，95%CI 1.45-2.79，P<0.001）独立相关。此外，进一步的分层分析表明，NED对生存的影响不受肿瘤位置、分化程度、T分期和远处转移状态的影响；然而，发现它与淋巴结转移有关。
NED与结直肠癌患者的不良生存结果相关，尤其是在淋巴结阳性的患者中。
