Is neuroendocrine differentiation a prognostic factor in poorly differentiated colorectal cancer?

Abstract

BackgroundTo determine the prognostic relevance of neuroendocrine differentiation in poorly differentiated colorectal cancer.MethodsThe clinicopathological features and survival of 70 patients with poorly differentiated colorectal cancer were analyzed retrospectively. Chromogranin A and synaptophysin were used as neuroendocrine markers. Patients were followed-up for more than 3 years or until death.ResultsOf these 70 patients, 36 showed neuroendocrine differentiation. In univariate prognostic analysis, the patients with lymph node metastasis (P < 0.001), advanced TNM stage (P < 0.001), and neuroendocrine differentiation (P = 0.003) tended to have a poor prognosis. However, only lymph node metastasis was associated with a poor prognosis in multivariate analysis (P < 0.001). Patients with neuroendocrine differentiation were associated with lymph node metastasis (P = 0.006).ConclusionsNeuroendocrine differentiation in poorly differentiated colorectal cancer was not a direct prognostic factor in these patients. Lymph node metastasis was a direct prognostic factor in these patients. Patients with neuroendocrine differentiation were associated with lymph node metastasis.

Correlation of Neuroendocrine Differentiation with Neuroendocrine Cell Hyperplasia and Vascular Endothelial Growth Factor in Colorectal Adenocarcinoma

“…Many studies utilized the conceivable relation between the existence of NE changes (hyperplasia and differentiation) in colorectal carcinomas and the prognosis. In the present study tumor with distant metastasis correlated to poor prognosis (P= 0.049), these findings are conformable with data of many authors like Chen et al (20); Volante et al (31); Liu et al (32), in which they found that NED correlated to stage of tumor. Volante et al (31) found that distant metastasis in CRC have more percentage of NED when compared to primary tumor.…”

“…The biological mechanisms depended on poorly differentiated CRC from NED and metastasis remained inconspicuous. Theoretically, NED could induce the growth and the metastatic ability via the neurohormonal material secretion (20). VEGF was positive in 63 % in the current study.…”

“…This study assessed the frequency of NED in tumor tissues, 42 cases were negative NED, while NED was expressed in 39 (48.1%) cases. Gulubova and Vlaykova (19); Chen et al (20) have detected NED differentiation in approximately 34.3%, 51.4% of colorectal cancer.…”

Neuroendocrine Differentiation in Conventional Colorectal Adenocarcinomas: Incidental Finding or Prognostic Biomarker?

“…Since such observations raise the question of the prognostic and clinical significance of neuroendocrine differentiation in these otherwise histologically inconspicuous conventional adenocarcinomas, a number of studies have dealt with this problem, but so far produced controversial results. While the extent of neuroendocrine differentiation was prognostically relevant in some studies, other studies were unable to confirm this statement [11][12][13][14][15][16][17][18][19]. Therefore, the prognostic assessment of colorectal adenocarcinomas with a neuroendocrine differentiation that is only demonstrable by immunohistochemistry remains a problem for diagnostic pathologists, especially if the neuroendocrine cell number appears to exceed the 30% cut-off level.…”

Development and validation of prognostic nomograms for patients with colon neuroendocrine neoplasms

“…The most commonly used predictive system for colon NENs is the AJCC TNM classification, which includes three clinical parameters: tumor size (T), lymph node status (N), and distant metastasis (M). Studies have shown that for other types of solid tumors, multiple factors affect the prognosis of tumors [ 28 , 29 ], but the TNM staging system has the most important prognostic value. However, for GEP-NENS, tumor differentiation is the most important prognostic indicator for disease course and progression [ 30 ].…”