Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO); IRCCS, Milan, Italy.
J Neuroendocrinol. 2021 May;33(5):e12971. doi: 10.1111/jne.12971. Epub 2021 Apr 19.
The recent World Health Organization classification for gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) classified poorly differentiated GEP-NENs into small cell and large cell categories. The present study aimed to assess the differences in outcomes between patients with both histological categories. The Surveillance, Epidemiology and End Results (SEER) database (1975-2016) was accessed and patients with small cell and large cell GEP-neuroendocrine carcinomas (NECs) were extracted. Differences in survival outcomes were explored through Kaplan-Meier survival estimates and multivariable Cox regression models. In total, 2204 patients with GEP-NEC were identified in the survival cohort, including 1698 patients with small cell NEC (77%) and 506 patients with large cell NEC (23%). Using Kaplan-Meier analysis/log-rank testing, large cell GEP-NEC was associated with better overall survival compared to small cell NEC (P < 0.01). Using multivariable Cox regression analysis, large cell GEP-NEC was associated with better overall survival (large cell GEP-NEC versus small cell GEP-NEC, hazard ratio = 0.77; 95% confidence interval = 0.68-0.86) and cancer-specific survival (large cell GEP-NEC versus small cell GEP-NEC, hazard ratio = 0.79; 95% 95% confidence interval = 0.69-0.91). Patients with small cell GEP-NEC have worse survival outcomes compared to those with large cell GEP-NEC. Further efforts are needed to identify biological differences and treatment sensitivities between both histological categories.
最近，世界卫生组织（WHO）对胃肠胰神经内分泌肿瘤（GEP-NENs）进行了分类，将分化差的 GEP-NEN 分为小细胞和大细胞两类。本研究旨在评估这两种组织学分类患者的预后差异。本研究检索了监测、流行病学和最终结果（SEER）数据库（1975-2016 年），提取了小细胞和大细胞 GEP-神经内分泌癌（NEC）患者。通过 Kaplan-Meier 生存估计和多变量 Cox 回归模型探讨了生存结果的差异。在生存队列中，共确定了 2204 例 GEP-NEC 患者，包括 1698 例小细胞 NEC（77%）和 506 例大细胞 NEC（23%）。Kaplan-Meier 分析/对数秩检验显示，与小细胞 NEC 相比，大细胞 GEP-NEC 的总生存期更好（P<0.01）。多变量 Cox 回归分析显示，与小细胞 GEP-NEC 相比，大细胞 GEP-NEC 与更好的总生存期相关（大细胞 GEP-NEC 比小细胞 GEP-NEC，风险比=0.77；95%置信区间=0.68-0.86）和癌症特异性生存期（大细胞 GEP-NEC 比小细胞 GEP-NEC，风险比=0.79；95%置信区间=0.69-0.91）。与大细胞 GEP-NEC 相比，小细胞 GEP-NEC 患者的生存结局较差。需要进一步努力识别两种组织学分类之间的生物学差异和治疗敏感性。
