Epidemiology and survival outcomes of colorectal mixed neuroendocrine–non-neuroendocrine neoplasms and neuroendocrine carcinoma

Mohammed O. Suraju, Kyle Freischlag, Denise Jacob, Dakota Thompson, Andrew Mckeen, Catherine Tran, Scott K. Sherman, Paolo Goffredo, Ronald J. Weigel, Imran Hassan

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2 Scopus citations

Abstract

Background: Mixed neuroendocrine–non-neuroendocrine neoplasms are a rare subtype of neuroendocrine neoplasm consisting of ≥30% each of neuroendocrine and non-neuroendocrine differentiation. Neuroendocrine carcinomas are poorly differentiated neuroendocrine tumors. The epidemiology and prognosis of colorectal mixed neuroendocrine–non-neuroendocrine neoplasms and neuroendocrine carcinomas are not clearly defined in the literature. We sought to examine the presentation, patterns of care, and outcomes of patients with mixed neuroendocrine–non-neuroendocrine neoplasms and neuroendocrine carcinomas. Methods: We identified patients diagnosed with stage I–III colorectal (excluding appendix) mixed neuroendocrine–non-neuroendocrine neoplasms or neuroendocrine carcinomas with only one-lifetime cancer diagnosis who underwent surgical resection between 2010 and 2018 from the National Cancer Database. We performed bidirectional selection to identify variables to include in a multivariable Cox proportional hazards model. Results: We identified 189 patients with a diagnosis of stage I to III colorectal mixed neuroendocrine–non-neuroendocrine neoplasms, 66% of whom had poorly differentiated tumors and 482 with neuroendocrine carcinomas. Among patients with stage III disease, 68% of patients with mixed neuroendocrine–non-neuroendocrine neoplasms and 54% of patients with neuroendocrine carcinomas received adjuvant chemotherapy. The median survival for the overall patients with mixed neuroendocrine–non-neuroendocrine neoplasms and neuroendocrine carcinomas cohorts were 38 and 42 months, respectively (P = .22), and the median survival for patients with mixed neuroendocrine–non-neuroendocrine neoplasms and neuroendocrine carcinomas with stage III disease were 30 and 25 months, respectively (P = .27). In multivariable analysis, fewer number of positive nodes and receipt of adjuvant chemotherapy were independently associated with decreased risk of mortality for patients with mixed neuroendocrine–non-neuroendocrine neoplasms and neuroendocrine carcinomas. Conclusion: Adjuvant chemotherapy is associated with improved survival in stage III mixed neuroendocrine–non-neuroendocrine neoplasms and neuroendocrine carcinomas. Future studies are warranted to identify subsets of patients benefiting most from adjuvant therapy.

Original languageEnglish (US)
Pages (from-to)735-742
Number of pages8
JournalSurgery (United States)
Volume175
Issue number3
DOIs
StatePublished - Mar 2024

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