Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of General Surgery, China-Japan Friendship Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2021 Dec 20;12:801741. doi: 10.3389/fendo.2021.801741. eCollection 2021.
Locally advanced and metastatic colorectal neuroendocrine neoplasm (NEN) is a rare disease with a dismal prognosis. We aimed to explore the value of the macroscopic morphology of NENs in the management of TNM stage II-IV colorectal NENs, which has not been fully elucidated in previous reports.
We retrospectively enrolled 125 eligible patients with TNM stage II-IV colorectal NENs who were diagnosed between 2000 and 2020 from three Chinese hospitals. All were categorized into either protruding or ulcerative NEN groups through endoscopic evaluation of their macroscopic morphology. Clinicopathological data were collected and compared between the two groups. Survival analysis was performed to assess the survival outcomes between the two groups.
A total of 77 and 48 patients had protruding and ulcerative NENs, respectively. Patients with ulcerative NENs had a larger median tumor size (P<0.001) and higher median Ki-67 index (P<0.001), and a larger proportion of these patients had grade G3 disease (P=0.001) and poorly differentiated neoplasms (P=0.001), as well as higher frequencies of T3 and T4 tumors (P=0.006) than patients with protruding NENs. In addition, patients with ulcerative NENs showed a much lower response to first-line chemotherapy [50% (95% CI: 27.3% - 72.7%) versus 20% (95% CI: 3.1% - 36.9%), P=0.03] and a worse 3-year progression-free survival (PFS) rate [19.7% (95% CI: 7.2% - 32.2%) versus 49.5% (95% CI: 37.5% - 61.5%), P=0.001] and 3-year overall survival (OS) rate [30.7% (95% CI: 15.6% - 45.8%) versus 76.9% (95% CI: 66.5% - 87.3%), P<0.001] than those with protruding NENs. The multivariate analysis results indicated that the macroscopic shape of NENs was an independent prognostic factor affecting both PFS (HR = 1.760, 95% CI: 1.024 - 3.026, P = 0.04) and OS (HR = 2.280, 95% CI: 1.123 - 4.628, P = 0.02).
Ulcerative NENs were more malignant and chemotherapy resistant than protruding NENs. Tumor macroscopic morphology is a valuable prognostic factor for stage II-IV colorectal NENs.
局部晚期和转移性结直肠神经内分泌肿瘤（NEN）是一种预后较差的罕见疾病。我们旨在探讨 NEN 的大体形态学在管理 II-IV 期结直肠 NEN 中的价值，这在以前的报告中尚未充分阐明。
我们回顾性纳入了 2000 年至 2020 年间来自三家中国医院的 125 名经病理证实的 II-IV 期结直肠 NEN 患者。所有患者均通过内镜评估其大体形态学分为隆起型或溃疡型 NEN 组。收集并比较两组的临床病理资料。进行生存分析以评估两组之间的生存结局。
共 77 例和 48 例患者分别为隆起型和溃疡型 NEN。溃疡型 NEN 患者的肿瘤最大径中位数更大（P<0.001），Ki-67 指数中位数更高（P<0.001），G3 级疾病（P=0.001）和低分化肿瘤的比例更高（P=0.001），T3 和 T4 期肿瘤的比例也更高（P=0.006）。此外，溃疡型 NEN 患者对一线化疗的反应率较低[50%（95%CI：27.3% - 72.7%）与 20%（95%CI：3.1% - 36.9%），P=0.03]，3 年无进展生存率（PFS）[19.7%（95%CI：7.2% - 32.2%）与 49.5%（95%CI：37.5% - 61.5%），P=0.001]和 3 年总生存率（OS）[30.7%（95%CI：15.6% - 45.8%）与 76.9%（95%CI：66.5% - 87.3%），P<0.001]均低于隆起型 NEN 患者。多变量分析结果表明，NEN 的大体形态是影响 PFS（HR=1.760，95%CI：1.024 - 3.026，P=0.04）和 OS（HR=2.280，95%CI：1.123 - 4.628，P=0.02）的独立预后因素。
溃疡型 NEN 比隆起型 NEN 更具恶性和化疗耐药性。肿瘤大体形态是 II-IV 期结直肠 NEN 的有价值的预后因素。
