Abstract：
BACKGROUND: Although correlation between center volume and survival has been reported for several complex cancers, it remains unknown if this is true for colorectal neuroendocrine carcinomas (CRNECs). We hypothesized that higher center annual volume of colorectal neuroendocrine neoplasm resections would be associated with overall survival (OS) for patients with CRNECs.
METHODS: Patients in the National Cancer Database diagnosed with stages I-III CRNEC between 2006 and 2018 and who underwent surgical resection were identified. The mean annual colorectal neuroendocrine neoplasm resection volume threshold associated with significantly worse mortality hazard was determined using restricted cubic splines. Kaplan-Meier (KM) method was used to compare OS, while Cox proportional hazards model was used for multivariable analysis.
RESULTS: There were 694 patients with CRNEC who met inclusion criteria across 1229 centers. Based on the cubic spline, centers treating fewer than one colorectal neuroendocrine neoplasm patient every 3 years on average had worse outcomes. Centers below this threshold were classified as low-volume (LV) centers corresponding with 42% of centers and about 15% of the patient cohort. In unadjusted survival analysis, LV patients had a median OS of 14 months (95% confidence interval [CI]: 10-19) while those treated at HV centers had a median OS of 33 months (95% CI: 25-49). In multivariable analysis, resection at a LV center was associated with increased risk of mortality (1.42 [95% CI: 1.01-2.00], p = 0.04).
CONCLUSIONS: CRNEC patients have a dire prognosis; however, treatment at an HV center may be associated with decreased risk of mortality.
METHODS: Patients in the National Cancer Database diagnosed with stages I-III CRNEC between 2006 and 2018 and who underwent surgical resection were identified. The mean annual colorectal neuroendocrine neoplasm resection volume threshold associated with significantly worse mortality hazard was determined using restricted cubic splines. Kaplan-Meier (KM) method was used to compare OS, while Cox proportional hazards model was used for multivariable analysis.
RESULTS: There were 694 patients with CRNEC who met inclusion criteria across 1229 centers. Based on the cubic spline, centers treating fewer than one colorectal neuroendocrine neoplasm patient every 3 years on average had worse outcomes. Centers below this threshold were classified as low-volume (LV) centers corresponding with 42% of centers and about 15% of the patient cohort. In unadjusted survival analysis, LV patients had a median OS of 14 months (95% confidence interval [CI]: 10-19) while those treated at HV centers had a median OS of 33 months (95% CI: 25-49). In multivariable analysis, resection at a LV center was associated with increased risk of mortality (1.42 [95% CI: 1.01-2.00], p = 0.04).
CONCLUSIONS: CRNEC patients have a dire prognosis; however, treatment at an HV center may be associated with decreased risk of mortality.
摘要：
背景：尽管已经报道了几种复杂癌症的中心体积与生存率之间的相关性，对于结直肠神经内分泌癌(CRNECs)是否如此,尚不清楚.我们假设较高的结直肠神经内分泌肿瘤切除中心年体积与CRNEC患者的总生存期（OS）相关。
方法：确定了国家癌症数据库中在2006年至2018年间诊断为I-III期CRNEC并接受手术切除的患者。使用有限的立方样条确定与死亡率明显恶化相关的平均年度结直肠神经内分泌肿瘤切除体积阈值。使用Kaplan-Meier(KM)方法比较OS，Cox比例风险模型用于多变量分析。
结果：在1229个中心共有694名符合纳入标准的CRNEC患者。基于三次样条，平均每3年治疗少于1例结直肠神经内分泌肿瘤患者的中心结局较差.低于该阈值的中心被分类为低容量(LV)中心,对应于42%的中心和约15%的患者队列。在未调整生存分析中，LV患者的中位OS为14个月（95％置信区间[CI]：10-19），而在HV中心接受治疗的患者的中位OS为33个月（95％CI：25-49）。在多变量分析中，左心室中心切除与死亡风险增加相关(1.42[95%CI:1.01-2.00],p=0.04)。
结论：CRNEC患者预后不良；然而，HV中心的治疗可能与降低死亡风险相关.
方法：确定了国家癌症数据库中在2006年至2018年间诊断为I-III期CRNEC并接受手术切除的患者。使用有限的立方样条确定与死亡率明显恶化相关的平均年度结直肠神经内分泌肿瘤切除体积阈值。使用Kaplan-Meier(KM)方法比较OS，Cox比例风险模型用于多变量分析。
结果：在1229个中心共有694名符合纳入标准的CRNEC患者。基于三次样条，平均每3年治疗少于1例结直肠神经内分泌肿瘤患者的中心结局较差.低于该阈值的中心被分类为低容量(LV)中心,对应于42%的中心和约15%的患者队列。在未调整生存分析中，LV患者的中位OS为14个月（95％置信区间[CI]：10-19），而在HV中心接受治疗的患者的中位OS为33个月（95％CI：25-49）。在多变量分析中，左心室中心切除与死亡风险增加相关(1.42[95%CI:1.01-2.00],p=0.04)。
结论：CRNEC患者预后不良；然而，HV中心的治疗可能与降低死亡风险相关.
