Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2019; 25(34): 5197-5209
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5197
Analysis of 72 patients with colorectal high-grade neuroendocrine neoplasms from three Chinese hospitals
Zhi-Jie Wang, Ke An, Rui Li, Wei Shen, Man-Dula Bao, Jin-Hua Tao, Jia-Nan Chen, Shi-Wen Mei, Hai-Yu Shen, Yun-Bin Ma, Fu-Qiang Zhao, Fang-Ze Wei, Qian Liu
Zhi-Jie Wang, Man-Dula Bao, Jia-Nan Chen, Shi-Wen Mei, Hai-Yu Shen, Yun-Bin Ma, Fu-Qiang Zhao, Fang-Ze Wei, Qian Liu, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Ke An, Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Rui Li, Department of General Surgery, Beijing Hospital, Beijing 100730, China
Wei Shen, Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou 730030, China
Jin-Hua Tao, Department of Colorectal Surgery, University of Chinese Academy of Sciences Zhejiang Cancer Hospital, Hangzhou 310022, China
Author contributions: Wang ZJ and Tao JH designed the research; An K, Li R, Shen W, Bao MDL, Ma YB, and Wei FZ collected the data; Chen JN, Mei SW, Shen HY, and Zhao FQ analyzed the data; Wang ZJ drafted the article; Liu Q revised the paper.
Supported by the Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences, No. 2017-12M-1-006.
Institutional review board statement: Our investigation received approval from the ethics committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: All patients signed an informed consent form before the study.
Conflict-of-interest statement: The authors declare that there is no conflict of interest in regard to this research.
Data sharing statement: No additional data are available.
STROBE statement: The authors have carefully read the STROBE statement checklist of items and prepared the manuscript based on the requirements of the STROBE statement checklist of items.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qian Liu, MD, Chief Doctor, Professor, Surgeon, Teacher, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. fcwpumch@163.com
Telephone: +86-10-87787110 Fax: +86-10-87787110
Received: July 1, 2019
Peer-review started: July 1, 2019
First decision: August 2, 2019
Revised: August 12, 2019
Accepted: August 19, 2019
Article in press: August 19, 2019
Published online: September 14, 2019
Abstract
BACKGROUND

Colorectal 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.

AIM

To delineate the clinicopathologic features of and explore the prognostic factors for this rare malignancy.

METHODS

This 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.

RESULTS

According 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.

CONCLUSION

Colorectal 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.

Keywords: Colon, Rectum, Neuroendocrine, Neoplasm, Metastasis, Prognosis

Core tip: Colorectal high-grade neuroendocrine neoplasms (HGNENs) are aggressive malignancies with an extremely low incidence. Many issues, such as their classification and therapy strategies, have been controversial for a long time. We conducted this study to delineate their clinicopathologic features and clinical outcomes. There is a trend to categorize colorectal HGNENs with good morphological differentiation as a subgroup different from high-grade neuroendocrine carcinomas in the newest World Health Organization classification. We introduced this classification into our study and compared the prognoses of different subgroups.