Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China.
Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China.
Int J Colorectal Dis. 2024 Oct 22;39(1):170. doi: 10.1007/s00384-024-04731-7.
This study compared survival and metastasis occurrence between colorectal neuroendocrine neoplasms (cNEN) and colorectal adenocarcinoma with neuroendocrine differentiation (cNED) and further explored their prognostic factors and treatment indicators.
Patients diagnosed as cNEN and cNED in West China Hospital from January 2009 to December 2020 were enrolled. The diagnosis and metastasis rates were calculated. Univariate and multivariate Cox analyses were conducted for progression-free survival (PFS) in cNEN surgical patients, and generalized linear regression was used for metastatic disease.
The study enrolled 435 patients, including 257 neuroendocrine tumors (NET), 52 neuroendocrine carcinomas (NEC), 29 mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN), and 97 NED patients, of whom 202 received local resection, and 233 received radical resection. Metastasis rates were higher in MiNEN and NEC groups compared to other groups (NED: 28.9%, MiNEN: 58.6%, NEC: 65.4%, NET: 8.6%, p < 0.001). The liver is the main metastatic site in cNEN, whereas cNED metastasized to various sites. For NEC and MiNEN patients, colon location (p = 0.002) and T stage > 2 (p = 0.040) were associated with disease progression separately. Independent risk factors for metastatic NET included tumor grade G2/G3 (p < 0.001), colon location (p = 0.001), size ≥ 1 cm (p = 0.005), and CK20 partial positive (p < 0.001).
cNEN show high metastatic capacity and are challenging to diagnose. More aggressive treatment and follow-up strategies are necessary for those patients. NET tumor grade higher than G2, size larger than 1 cm, or located in the colon should be managed with radical surgery.
本研究比较了结直肠神经内分泌肿瘤（cNEN）和伴有神经内分泌分化的结直肠腺癌（cNED）的生存和转移发生率，并进一步探讨了它们的预后因素和治疗指标。
纳入 2009 年 1 月至 2020 年 12 月在华西医院诊断为 cNEN 和 cNED 的患者。计算诊断和转移率。对 cNEN 手术患者的无进展生存期（PFS）进行单因素和多因素 Cox 分析，并对转移性疾病进行广义线性回归。
本研究纳入 435 例患者，包括 257 例神经内分泌肿瘤（NET）、52 例神经内分泌癌（NEC）、29 例混合性神经内分泌-非神经内分泌肿瘤（MiNEN）和 97 例伴有神经内分泌分化的腺癌（NED）患者，其中 202 例接受局部切除术，233 例接受根治性切除术。MiNEN 和 NEC 组的转移率高于其他组（NED：28.9%，MiNEN：58.6%，NEC：65.4%，NET：8.6%，p<0.001）。cNEN 的主要转移部位是肝脏，而 cNED 则转移到多个部位。对于 NEC 和 MiNEN 患者，肿瘤位置（p=0.002）和 T 分期>2（p=0.040）分别与疾病进展有关。转移性 NET 的独立危险因素包括肿瘤分级 G2/G3（p<0.001）、肿瘤位置位于结肠（p=0.001）、肿瘤大小≥1cm（p=0.005）和 CK20 部分阳性（p<0.001）。
cNEN 具有较高的转移能力，诊断困难。对于这些患者，需要采取更积极的治疗和随访策略。NET 肿瘤分级高于 G2、肿瘤大小大于 1cm 或位于结肠时，应采用根治性手术治疗。
