Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China.
Tech Coloproctol. 2023 Nov;27(11):1017-1024. doi: 10.1007/s10151-023-02786-2. Epub 2023 Mar 30.
As a rare gastrointestinal neoplasm, the demographic, clinicopathological, and prognostic characteristics of mixed adenoneuroendocrine carcinoma (MANEC) remain unclear. The purpose of this study was to evaluate its biological features, survival outcome, and prognostic factors.
From the Surveillance, Epidemiology, and End Results (SEER) database, we retrospectively reviewed clinicopathological and survival data of 513 patients who were histopathologically diagnosed with MANEC of the appendix and colorectum bettween 2004 and 2015. The clinicopathological features and survival outcomes of MANEC located at different anatomical locations were compared, and predictive factors for cancer-specific survival (CSS) and overall survival (OS) were assessed.
In terms of anatomical distribution of MANEC, the appendix (64.5%, 331/513) was more frequently involved, followed by colon (28.1%, 144/513) and rectum (7.4%, 38/513). The MANEC at different anatomical locations had a distinct clinicopathological characteristic, and colorectal MANEC was significantly associated with more aggressive biological features. The survival outcomes of appendiceal MANEC were significantly better than that of colorectal MANEC (3-year CSS rate 73.8% vs 59.4%, P = 0.010; 3-year OS 69.2% vs 48.3%, P < 0.001). In addition, hemicolectomy had a better survival benefit than appendicectomy for patients with appendiceal MANEC, regardless of lymph node metastasis (P < 0.05). Tumor location, histology grade III, tumor size > 2 cm, T3-T4 stage, lymph node metastasis, and distant metastasis were independent prognostic factors for patients with MANEC.
Tumor location had an important prognostic significance for MANEC. As an uncommon clinical entity, colorectal MANEC had more aggressive biological features and worse prognosis than its appendiceal counterpart. The standard surgical procedure and clinical management strategy for MANEC need to be established.
混合性腺神经内分泌癌（MANEC）是一种罕见的胃肠道肿瘤，其人口统计学、临床病理学和预后特征尚不清楚。本研究旨在评估其生物学特征、生存结局和预后因素。
我们从监测、流行病学和最终结果（SEER）数据库中回顾性分析了 2004 年至 2015 年间经组织病理学诊断为阑尾和结直肠 MANEC 的 513 例患者的临床病理和生存数据。比较了 MANEC 位于不同解剖部位的临床病理特征和生存结局，并评估了癌症特异性生存（CSS）和总生存（OS）的预测因素。
就 MANEC 的解剖分布而言，阑尾（64.5%，331/513）受累更为常见，其次是结肠（28.1%，144/513）和直肠（7.4%，38/513）。MANEC 位于不同解剖部位具有明显的临床病理学特征，结直肠 MANEC 与更具侵袭性的生物学特征显著相关。阑尾 MANEC 的生存结局明显优于结直肠 MANEC（3 年 CSS 率 73.8%比 59.4%，P=0.010；3 年 OS 率 69.2%比 48.3%，P<0.001）。此外，对于阑尾 MANEC 患者，半结肠切除术比阑尾切除术有更好的生存获益，无论是否存在淋巴结转移（P<0.05）。肿瘤位置、组织学分级 III 级、肿瘤大小>2cm、T3-T4 期、淋巴结转移和远处转移是 MANEC 患者的独立预后因素。
肿瘤位置对 MANEC 具有重要的预后意义。作为一种罕见的临床实体，结直肠 MANEC 比阑尾 MANEC 具有更具侵袭性的生物学特征和更差的预后。需要制定 MANEC 的标准手术程序和临床管理策略。
