Michael Anita, Nath Debashis K
Internal Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, IND.
Internal Medicine, Queen Elizabeth Hospital Kings Lynn, King's Lynn, GBR.
Cureus. 2021 Jul 26;13(7):e16645. doi: 10.7759/cureus.16645. eCollection 2021 Jul.
Mixed adeno-neuroendocrine carcinomas (MANEC) is a rare pathological diagnosis characterized by the presence of both adeno-carcinomatous and neuroendocrine differentiation with each component comprising 30% of the tumor. This literature review is aimed at the extraction of all existing clinical studies and reviews on colorectal MANEC so as to ensure that a suitable chemotherapeutic regimen is chosen to improve survival outcomes and prognosis of the disease. Parallel search strategies were employed to extract past 10 years articles from PubMed, PubMed Central and Google Scholar databases. A total of 30 records consisting of one clinical trial, five retrospective cohort studies, one case control study, one case series, 16 case reports and six review papers were shortlisted. Chemotherapeutic regimens that were administered as an adjuvant and a neoadjuvant therapy were analyzed with their survival outcomes. The overall survival rate of those administered with neoadjuvant and adjuvant therapy can be as high as 57.4% and 69%, respectively. Multiple chemotherapeutic regimens were employed in colorectal MANEC and superiority of one regimen over the other can't be established. Any drug or combination of drugs that is responsive against either of the MANEC components is found to be effective against the tumor. However, excellent responsiveness has been found with 5-fluorouracil regimens as a neoadjuvant therapy and platinum-based combinations as an adjuvant therapy. XELOX, streptozocin and S1 regimens also prove to be drugs of choice in aggressive and metastasized disease conditions. Our analysis allows for improved chemotherapeutic management of individuals with colorectal MANEC and establishes an increased potential for use of streptozocin therapy in the clinical setting. However, newer drugs like amrubicin require further research prior to describing its efficacy in colorectal MANEC.
混合性腺神经内分泌癌（MANEC）是一种罕见的病理诊断，其特征是同时存在腺癌性和神经内分泌分化，且每个成分占肿瘤的30%。这篇文献综述旨在提取所有关于结直肠MANEC的现有临床研究和综述，以确保选择合适的化疗方案来改善该疾病的生存结果和预后。采用平行检索策略从PubMed、PubMed Central和谷歌学术数据库中提取过去10年的文章。共筛选出30条记录，包括1项临床试验、5项回顾性队列研究、1项病例对照研究、1项病例系列、16项病例报告和6篇综述论文。分析了作为辅助治疗和新辅助治疗使用的化疗方案及其生存结果。接受新辅助治疗和辅助治疗的患者的总生存率分别可高达57.4%和69%。结直肠MANEC采用了多种化疗方案，无法确定一种方案优于另一种方案。发现任何对MANEC任何一种成分有反应的药物或药物组合对肿瘤都有效。然而，已发现5-氟尿嘧啶方案作为新辅助治疗具有良好的反应性，铂类联合方案作为辅助治疗具有良好的反应性。XELOX、链脲佐菌素和S1方案在侵袭性和转移性疾病情况下也被证明是首选药物。我们的分析有助于改善结直肠MANEC患者的化疗管理，并确定在临床环境中使用链脲佐菌素治疗的更大潜力。然而，像氨柔比星这样的新药在描述其在结直肠MANEC中的疗效之前需要进一步研究。
