Analysis of 72 patients with colorectal high-grade neuroendocrine neoplasms from three Chinese hospitals

Abstract

BACKGROUNDColorectal high-grade neuroendocrine neoplasms (HGNENs) are rare and constitute less than 1% of all colorectal malignancies. Based on their morphological differentiation and proliferation identity, these neoplasms present heterogeneous clinicopathologic features. Opinions regarding treatment strategies for and improvement of the clinical outcomes of these patients remain controversial.AIMTo delineate the clinicopathologic features of and explore the prognostic factors for this rare malignancy.METHODSThis observational study reviewed the data of 72 consecutive patients with colorectal HGNENs from three Chinese hospitals between 2000 and 2019. The clinicopathologic characteristics and follow-up data were carefully collected from their medical records, outpatient reexaminations, and telephone interviews. A survival analysis was conducted to evaluate their outcomes and to identify the prognostic factors for this disease.RESULTSAccording to the latest recommendations for the classification and nomenclature of colorectal HGNENs, 61 (84.7%) patients in our cohort had poorly differentiated neoplasms, which were categorized as high-grade neuroendocrine carcinomas (HGNECs), and the remaining 11 (15.3%) patients had well differentiated neoplasms, which were categorized as high-grade neuroendocrine tumors (HGNETs). Most of the neoplasms (63.9%) were located at the rectum. More than half of the patients (51.4%) presented with distant metastasis at the date of diagnosis. All patients were followed for a median duration of 15.5 mo. In the entire cohort, the median survival time was 31 mo, and the 3-year and 5-year survival rates were 44.3% and 36.3%, respectively. Both the univariate and multivariate analyses demonstrated that increasing age, HGNEC type, and distant metastasis were risk factors for poor clinical outcomes.CONCLUSIONColorectal HGNENs are rare and aggressive malignancies with poor clinical outcomes. However, patients with younger age, good morphological differentiation, and without metastatic disease can have a relatively favorable prognosis.

Nomograms for Predicting Survival Outcomes in Patients with Neuroendocrine Neoplasms of the Gallbladder Undergoing Primary Tumor Resection: A Population-Based Study

“…Age as a personal characteristic is widely considered to be a prognostic predictor for gallbladder cancer as well as neuroendocrine neoplasms in other sites, such as gastric NENs, colorectal NENs, and pancreatic NENs [ 16 , 17 , 18 , 19 , 20 ]. With age, the chance of cancer-causing genetic mutations increases.…”

Metastatic rectal neuroendocrine carcinoma presenting with treatment-refractory immune thrombocytopenia: A case report and literature review

“…Male sex, advanced age, and left-sided cancer have been linked to poor prognosis in some studies. [ 6 , 7 , 14 , 15 , 24 , 25 , 28 , 50 ] Field and colleagues studied 1208 patients with CRNEC from a national cancer database registry spanning from 2004 to 2015 where most patients had advanced disease. The median age was 65 years; 64.4% of them received chemotherapy, 61.3% received some form of surgery, and 21.2% received radiation therapy.…”

Gastroenteropancreatic neuroendocrine tumours – an overview

“…Colorectal NENs present a mean Ki-67 proliferative index of 21%, and the majority of these tumours are well-differentiated (type 1 and 2). The staining of poorly differentiated neoplasms for synaptophysin or CgA is less intense compared to that of well-differentiated tumours [116,117]. Colorectal NECs are morphologically similar to neuroendocrine carcinoma of the lung, and they can be large or small cell carcinomas.…”

“…The carcinoid syndrome is usually absent because most NECs are nonfunctional. Unfortunately, at the date of diagnosis the tumour is large and advanced in most of cases [116]. Colorectal NETs have similar clinical presentation.…”