Abstract:
Objective To identify clinicopathological characteristics and prognostic factors of colorectal neuroendocrine neoplasms (CRNENs).
Methods Based on the classification criteria of neuroendocrine neoplasms in the fifth edition of the World Health Organization (WHO) classification of the digestive system, 185 cases of CRNENs undergoing radical surgery and local resection at Tianjin Medical University Cancer Institute & Hospital between March 2011 and December 2020 were studied retrospectively. Clinicopathological characteristics were compared among different grades of CRNENs, and survival analysis of all cases and each grade was performed.
Result The entire cohort comprised 142 cases (76.8%) of neuroendocrine tumor (NET) G1, 18 cases (9.7%) of NET G2, 3 cases (1.6%) of NET G3, 14 cases (7.6%) of neuroendocrine carcinoma (NEC), and 8 cases (4.3%) of mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN). Patients with higher-grade CRNENs tended to exhibit metastasis to regional lymph nodes and have larger tumor diameter. When diagnosed, most patients were in the advanced disease stages (P<0.05 for all). However, individual NET G1/G2 also exhibited aggressive biological behavior and lymph node or distant metastasis. Ki-67 index in NEC was significantly higher than that in NET G3 (t=5.569, P<0.001). The overall survival (OS) and progression-free survival (PFS) of patients with different WHO classifications were significantly different (P<0.05 for all).
Conclusions CRNENs are heterogeneous tumors; however, regardless of grade, CRNENs are malignant and require a combination of clinical stage and other conditions to decide the treatment modality. Since, the pathogenesis of CRNENs is unknown, the differential diagnosis between NET G3 and NEC is difficult; furthermore, uniform treatment criteria for NET G3 and MiNEN are inadequate. Thus, multicenter large-sample studies to improve the diagnosis and treatment are required.
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