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. 2019 Apr;26(4):1127-1133.
doi: 10.1245/s10434-019-07203-3. Epub 2019 Jan 31.

Survival in Patients with High-Grade Colorectal Neuroendocrine Carcinomas: The Role of Surgery and Chemotherapy

Adam C Fields  1 , Pamela Lu  2   3 , Benjamin M Vierra  2 , Frances Hu  2 , Jennifer Irani  2 , Ronald Bleday  2 , Joel E Goldberg  2 , Garrett M Nash  4 , Nelya Melnitchouk  5   6
Affiliations

Survival in Patients with High-Grade Colorectal Neuroendocrine Carcinomas: The Role of Surgery and Chemotherapy

Adam C Fields et al. Ann Surg Oncol. 2019 Apr.

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.

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Figures

FIG. 1
FIG. 1
Patient selection
FIG. 2
FIG. 2
Adjusted survival stratified by undergoing surgery
FIG. 3
FIG. 3
Adjusted survival stratified by a lymph node status or b resection margin status
FIG. 4
FIG. 4
Adjusted survival for patients with a localized disease and b metastatic disease, stratified by treatment with surgery and chemotherapy
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