目的:作为一种罕见的胃肠道肿瘤,人口统计,临床病理,和混合性腺神经内分泌癌(MANEC)的预后特征仍不清楚。这项研究的目的是评估其生物学特征,生存结果,和预后因素。
方法:从监测来看,流行病学,和最终结果(SEER)数据库,我们回顾性分析了2004年至2015年组织病理学诊断为阑尾和结肠直肠MANEC的513例患者的临床病理和生存数据.比较位于不同解剖位置的MANEC的临床病理特征和生存结局。并评估了癌症特异性生存率(CSS)和总生存率(OS)的预测因素。
结果:就MANEC的解剖分布而言,附录(64.5%,331/513)更频繁地参与,其次是结肠(28.1%,144/513)和直肠(7.4%,38/513)。不同解剖位置的MANEC具有不同的临床病理特征,结直肠MANEC与更具侵袭性的生物学特征显著相关。阑尾MANEC的生存结局明显优于结直肠MANEC(3年CSS率73.8%vs59.4%,P=0.010;3年OS为69.2%vs48.3%,P<0.001)。此外,对于阑尾MANEC患者,半结肠切除术比阑尾切除术有更好的生存获益,无论有无淋巴结转移(P<0.05)。肿瘤位置,组织学III级,肿瘤大小>2厘米,T3-T4级,淋巴结转移,远处转移是MANEC患者的独立预后因素。
结论:肿瘤定位对MANEC具有重要的预后意义。作为一个不常见的临床实体,结直肠MANEC比其阑尾对应物具有更积极的生物学特征和更差的预后.需要建立MANEC的标准外科手术和临床管理策略。
As a rare gastrointestinal neoplasm, the demographic, clinicopathological, and prognostic characteristics of mixed adenoneuroendocrine carcinoma (MANEC) remain unclear. The purpose of this study was to evaluate its biological features, survival outcome, and prognostic factors.
From the Surveillance, Epidemiology, and End Results (SEER) database, we retrospectively reviewed clinicopathological and survival data of 513 patients who were histopathologically diagnosed with MANEC of the appendix and colorectum bettween 2004 and 2015. The clinicopathological features and survival outcomes of MANEC located at different anatomical locations were compared, and predictive factors for cancer-specific survival (CSS) and overall survival (OS) were assessed.
In terms of anatomical distribution of MANEC, the appendix (64.5%, 331/513) was more frequently involved, followed by colon (28.1%, 144/513) and rectum (7.4%, 38/513). The MANEC at different anatomical locations had a distinct clinicopathological characteristic, and colorectal MANEC was significantly associated with more aggressive biological features. The survival outcomes of appendiceal MANEC were significantly better than that of colorectal MANEC (3-year CSS rate 73.8% vs 59.4%, P = 0.010; 3-year OS 69.2% vs 48.3%, P < 0.001). In addition, hemicolectomy had a better survival benefit than appendicectomy for patients with appendiceal MANEC, regardless of lymph node metastasis (P < 0.05). Tumor location, histology grade III, tumor size > 2 cm, T3-T4 stage, lymph node metastasis, and distant metastasis were independent prognostic factors for patients with MANEC.
Tumor location had an important prognostic significance for MANEC. As an uncommon clinical entity, colorectal MANEC had more aggressive biological features and worse prognosis than its appendiceal counterpart. The standard surgical procedure and clinical management strategy for MANEC need to be established.