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Abstract：
Background: Neuroendocrine carcinomas (NECs) of the tubular gastrointestinal tract (GI-NECs) are rare and associated with worse clinical outcomes. This population-based study aims to highlight key demographics, clinicopathological factors, and survival outcomes in the US population. Methods: Data from 10,387 patients with GI-NECs were extracted from the Surveillance, Epidemiology, and End Result (SEER) database from 2000 to 2020. Results: Most patients were >40 years old at the time of presentation with a median age of 63 years old, with almost equal ethnic distribution per US population data. The most common primary tumor site was the small intestine (33.6%). The metastatic spread was localized in 34.8%, regional in 27.8%, and distant in 37.3% of cases, and the liver was the most common site of metastasis (19.9%) in known cases of metastases. Most NEC patients underwent surgery, presenting the highest 5-year overall survival of 73.2% with a 95% confidence interval (CI) (95% CI 72.0-74.4%), while chemotherapy alone had the lowest 5-year survival of 8.0% (95% CI 6.4-10.0%). Compared to men, women had a superior 5-year survival rate of 59.0% (95% CI 57.6-60.5%). On multivariate analysis, age > 65 (HR 2.49, 95% CI 2.36-2.54%, p ≤ 0.001), distant metastasis (HR 2.57, 95% CI 2.52-2.62%, p ≤ 0.001), tumor size > 4 mm (HR 1.98, 95%, CI 1.70-2.31%, p ≤ 0.001), esophageal (HR 1.49, 95% CI 0.86-2.58%, p ≤ 0.001), transverse colon (HR 1.95, 95% CI 1.15-3.33%, p ≤ 0.01), descending colon (HR 2.12, 95% CI 1.12, 3.97%, p = 0.02) anorectal sites, and liver or lung metastases were associated with worse survival. Surgical intervention and tumors located in the small intestine or appendix showed a better prognosis. Conclusion: GI-NECs are a group of rare malignancies associated with a poor prognosis. Therefore, epidemiological studies analyzing national databases may be the best alternative to have a more comprehensive understanding of this condition, assess the impact of current practices, and generate prognosis tools.
摘要：
背景：管状胃肠道（GI-NECs）的神经内分泌癌（NECs）很少见，并且临床预后较差。这项基于人群的研究旨在突出关键的人口统计数据，临床病理因素,和美国人口的生存结果。方法：从监测中提取10387例GI-NEC患者的数据，流行病学,和2000年至2020年的最终结果(SEER)数据库。结果：大多数患者在就诊时年龄>40岁，中位年龄为63岁，每个美国人口数据的种族分布几乎相等。最常见的原发肿瘤部位是小肠(33.6%)。转移性扩散局部为34.8％，区域27.8%，在37.3%的病例中，在已知的转移病例中，肝脏是最常见的转移部位（19.9％）。大多数NEC患者接受了手术，5年总生存率最高，为73.2%，置信区间为95%（95%CI为72.0-74.4%），而单纯化疗的5年生存率最低,为8.0%(95%CI6.4-10.0%).和男人相比,女性的5年生存率较高,为59.0%(95%CI57.6~60.5%).在多变量分析中，年龄>65（HR2.49，95%CI2.36-2.54%，p≤0.001)，远处转移（HR2.57，95%CI2.52-2.62%，p≤0.001)，肿瘤大小>4毫米(HR1.98，95%，CI1.70-2.31%，p≤0.001)，食管（HR1.49，95%CI0.86-2.58%，p≤0.001)，横结肠（HR1.95，95%CI1.15-3.33%，p≤0.01),降结肠（HR2.12，95%CI1.12，3.97%，p=0.02)肛门直肠部位，肝或肺转移与较差的生存率相关。手术干预和位于小肠或阑尾的肿瘤显示出更好的预后。结论：GI-NECs是一组罕见的恶性肿瘤，预后不良。因此,分析国家数据库的流行病学研究可能是对这种情况有更全面了解的最佳选择，评估当前做法的影响，并生成预后工具。
