Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2021; 27(21): 2895-2909
Published online Jun 7, 2021. doi: 10.3748/wjg.v27.i21.2895
Clinicopathological characteristics and prognosis of 232 patients with poorly differentiated gastric neuroendocrine neoplasms
Deng Han, Yuan-Liang Li, Zhi-Wei Zhou, Fei Yin, Jie Chen, Fang Liu, Yan-Fen Shi, Wei Wang, Yu Zhang, Xian-Jun Yu, Jian-Ming Xu, Run-Xiang Yang, Chao Tian, Jie Luo, Huang-Ying Tan
Deng Han, Yuan-Liang Li, Chao Tian, Huang-Ying Tan, Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing 100029, China
Zhi-Wei Zhou, Wei Wang, Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Fei Yin, Department of Gastroenterology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Jie Chen, Yu Zhang, Department of Gastroenterology, The First Affiliated Hospital Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
Fang Liu, Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
Yan-Fen Shi, Jie Luo, Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
Xian-Jun Yu, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Xian-Jun Yu, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Xian-Jun Yu, Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
Xian-Jun Yu, Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
Jian-Ming Xu, Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing 100071, China
Run-Xiang Yang, Second Department of Internal Medicine, Yunnan Tumor Hospital, Kunming 650118, Yunnan Province, China
Author contributions: Han D and Li YL made equal contributions to this paper and should be regarded as a co-first authors; Han D collected and analyzed the data and wrote the manuscript; Li YL collected and analyzed the data; Zhou ZW, Yin F, Chen J, Yu XJ, Xu JM, and Yang RX provided data support; Wang W, Zhang Y, and Tian C helped with the follow-up of the patients; Liu F performed endoscopic examinations; Shi YF and Luo J reviewed the specimens for pathological diagnosis; Tan HY designed the study and critically revised the manuscript; all authors read and approved the final manuscript.
Supported by National Key R&D Program of China, No. 2019YFB1309704.
Institutional review board statement: This study was approved by the Clinical Research Ethics Committee of China-Japan Friendship Hospital (No. 2019-24-K18-1).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no competing interests to declare.
Data sharing statement: The data used to support the findings of this study are available from the various centers.
Open-Access: This article 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 NonCommercial (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: Huang-Ying Tan, MD, PhD, Chief Physician, Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China. tanhuangying@263.net
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: April 5, 2021
Revised: April 14, 2021
Accepted: May 7, 2021
Article in press: May 7, 2021
Published online: June 7, 2021
Processing time: 120 Days and 22.8 Hours
ARTICLE HIGHLIGHTS
Research background

Poorly differentiated gastric neuroendocrine neoplasm (PDGNEN) is a rare tumor, but its incidence is gradually increasing. The clinical understanding of PDGNENs is limited, and a completely unified conclusion is difficult to determine. This study included 232 patients with PDGNENs from multiple centers in China and statistically analyzed the clinicopathological characteristics and prognostic factors of the patients, aiming to further standardize and systemize the diagnosis and treatment of PDGNENs.

Research motivation

This study aimed to explore the clinicopathological characteristics and prognostic factors for patients with PDGNENs, improve clinicians’ awareness of this disease, reduce the misdiagnosis and missed diagnosis of PDGNENs, and achieve early detection, early diagnosis, and early treatment.

Research objectives

This study analyzed the clinicopathological characteristics and prognostic factors of patients with PDGNENs to identify independent risk factors that potentially affect prognosis. By interfering with independent prognostic risk factors for PDGNENs, the quality of life of patients can be further improved and the survival period be prolonged.

Research methods

This study was a retrospective study and included 232 patients with PDGNENs treated at seven centers in China from March 2007 to November 2019. The data were analyzed using the Kaplan-Meier method to evaluate the survival of patients. Single-factor analysis was performed using the log-rank test, and the Cox proportional hazard regression model was used to explore the risk factors that affect patient prognosis.

Research results

Among the 232 patients with PDGNENs, 113 (49.34%) patients had stage III tumors and 86 (37.55%) had stage IV tumors. The tumors were mainly (89.17%) solitary and located in the upper third of the stomach (cardia and fundus of stomach: 115/215, 53.49%). Most lesions were ulcers (157/232, 67.67%), with an average diameter of 4.66 cm. In terms of tumor invasion, the majority of tumors invaded the serosa (116/198, 58.58%). The median survival time of the 232 patients was 13.50 mo (range, 7-31 mo), and the overall 1-year, 3-year, and 5-year survival rates were 49%, 19%, and 5%, respectively.

Research conclusions

According to univariate analysis, tumor number, tumor diameter, gastric invasion status, American Joint Committee on Cancer (AJCC) stage, and distant metastasis status were prognostic factors for patients with PDGNENs. Multivariate analysis showed that tumor number, tumor diameter, AJCC stage, and distant metastasis status were independent prognostic factors for patients with PDGNENs.

Research perspectives

This study provides novel insights into the diagnosis and treatment of PDGNENs and the risk factors related to the prognosis. In the future, prospective, multicenter, large-scale research is still needed.