Adam C Fields1, Pamela Lu2,3, Benjamin M Vierra2, Frances Hu2, Jennifer Irani2, Ronald Bleday2, Joel E Goldberg2, Garrett M Nash4, Nelya Melnitchouk5,6. 1. Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. acfields@partners.org. 2. Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 3. Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 4. Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. nmelnitchouk@bwh.harvard.edu. 6. Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. nmelnitchouk@bwh.harvard.edu.
Abstract
BACKGROUND: Colorectal neuroendocrine tumors are a rare malignancy, yet their incidence appears to be increasing. The optimal treatment for the high-grade subset of these tumors remains unclear. We aimed to examine the relationship between different treatment modalities and outcomes for patients with high-grade neuroendocrine carcinomas (HGNECs) of the colon and rectum. METHODS: The National Cancer Database (2004-2015) was used to identify patients diagnosed with colorectal HGNECs. The primary outcome was overall survival. A Cox Proportional hazard model was used to identify risk factors for survival. RESULTS: Overall, 1208 patients had HGNECs; 452 (37.4%) patients had primary tumors of the rectum, and 756 (62.5%) patients had primary tumors of the colon. A total of 564 (46.7%) patients presented with stage IV disease. The median survival was 9.0 months [95% confidence interval (CI) 8.2-9.8]. In multivariable analysis, surgical resection [hazard ratio (HR) 0.54, 95% CI 0.44-0.66; p < 0.001], chemotherapy (HR 0.74, 95% CI 0.69-0.79; p < 0.001), and rectum as the primary site of tumor (HR 0.62, 95% CI 0.51-0.76; p < 0.001) were associated with better overall survival, while older age (HR 1.01, 95% CI 1.00-1.01; p = 0.02) and the presence of metastatic disease (HR 3.34, 95% CI 2.69-4.15; p < 0.001) were associated with worse survival. CONCLUSIONS: Patients with colorectal HGNECs selected for chemotherapy and surgical resection of the primary tumor demonstrated better overall survival than those managed without resection. Patients who were able to undergo systemic chemotherapy may benefit from potentially curative resection of the primary tumor.
BACKGROUND:Colorectal neuroendocrine tumors are a rare malignancy, yet their incidence appears to be increasing. The optimal treatment for the high-grade subset of these tumors remains unclear. We aimed to examine the relationship between different treatment modalities and outcomes for patients with high-grade neuroendocrine carcinomas (HGNECs) of the colon and rectum. METHODS: The National Cancer Database (2004-2015) was used to identify patients diagnosed with colorectal HGNECs. The primary outcome was overall survival. A Cox Proportional hazard model was used to identify risk factors for survival. RESULTS: Overall, 1208 patients had HGNECs; 452 (37.4%) patients had primary tumors of the rectum, and 756 (62.5%) patients had primary tumors of the colon. A total of 564 (46.7%) patients presented with stage IV disease. The median survival was 9.0 months [95% confidence interval (CI) 8.2-9.8]. In multivariable analysis, surgical resection [hazard ratio (HR) 0.54, 95% CI 0.44-0.66; p < 0.001], chemotherapy (HR 0.74, 95% CI 0.69-0.79; p < 0.001), and rectum as the primary site of tumor (HR 0.62, 95% CI 0.51-0.76; p < 0.001) were associated with better overall survival, while older age (HR 1.01, 95% CI 1.00-1.01; p = 0.02) and the presence of metastatic disease (HR 3.34, 95% CI 2.69-4.15; p < 0.001) were associated with worse survival. CONCLUSIONS:Patients with colorectal HGNECs selected for chemotherapy and surgical resection of the primary tumor demonstrated better overall survival than those managed without resection. Patients who were able to undergo systemic chemotherapy may benefit from potentially curative resection of the primary tumor.
Authors: Hakan Ahlman; Ola Nilsson; Anne M McNicol; Philippe Ruszniewski; Bruno Niederle; Jens Ricke; Robert Jensen; Beata Kos-Kudła; Kjell Oberg; Juan M O'Connor; Marianne E Pavel; Marie-Pierre Vullierme Journal: Neuroendocrinology Date: 2007-10-16 Impact factor: 4.914
Authors: Pamela L Kunz; Diane Reidy-Lagunes; Lowell B Anthony; Erin M Bertino; Kari Brendtro; Jennifer A Chan; Herbert Chen; Robert T Jensen; Michelle Kang Kim; David S Klimstra; Matthew H Kulke; Eric H Liu; David C Metz; Alexandria T Phan; Rebecca S Sippel; Jonathan R Strosberg; James C Yao Journal: Pancreas Date: 2013-05 Impact factor: 3.327
Authors: H Sorbye; S Welin; S W Langer; L W Vestermark; N Holt; P Osterlund; S Dueland; E Hofsli; M G Guren; K Ohrling; E Birkemeyer; E Thiis-Evensen; M Biagini; H Gronbaek; L M Soveri; I H Olsen; B Federspiel; J Assmus; E T Janson; U Knigge Journal: Ann Oncol Date: 2012-09-11 Impact factor: 32.976
Authors: Jinru Shia; Laura H Tang; Martin R Weiser; Baruch Brenner; N Volkan Adsay; Edward B Stelow; Leonard B Saltz; Jing Qin; Ron Landmann; Gregory D Leonard; Deepti Dhall; Larissa Temple; Jose G Guillem; Philip B Paty; David Kelsen; W Douglas Wong; David S Klimstra Journal: Am J Surg Pathol Date: 2008-05 Impact factor: 6.394
Authors: P E Bernick; D S Klimstra; J Shia; B Minsky; L Saltz; W Shi; H Thaler; J Guillem; P Paty; A M Cohen; W D Wong Journal: Dis Colon Rectum Date: 2004-02 Impact factor: 4.585