| Objective To evaluate the clinicopathologic factors associated with prognosis and explore the survival differences between patients with colon and rectal neuroendocrine neoplasms(NENs)in different stages.Methods The SEER*Stat software was used to identify patients whose pathologicaldiagnosis were colorectal NENs from 1988 to 2014.To calculate the age at diagnosis,sex,race,marital status,stage,tumor grade and surgical treatment based on retrospective analysis.The comparisons of classification variable data and numerical variables were conducted by Chi Square test and t test,respectively.Univariate and Cox multivariate regression analyses were applied to evaluate factors that influenced prognosis.The Kaplan-Meier method was used to calculate the cumulative survival rate,and the significant difference was evaluated by the log-rank test.ResultsThe average age of 8679 patients with colorectal NENs included in this study was 57.38±12.91 years.The number of male and female were 4163(47.9%)and 4516(52.1%),and the rate was 1:1.08.Of them,5762(66.3%)were white,and 4892(56.3%)were married.Of all the patients,2036(23.5%)patients were classified as well differentiated;600(6.9%)as moderately differentiated;970(11.2%)as poorly differentiated and 468(5.4%)as undifferentiated.And 4661(53.7%)patients were classified as stage?;700(8.1%)as?;1337(15.4%)as?and 1981(22.8%)as?. Out of the patients studied,3242(37.4%)were colon NENs and 5437(62.6%)rectal.Out of the patients with colon NENs,1681(51.9%)were cecum.When analyzed separately,the average age for rectal NENs was 54.95±11.77 years,while the average age for colon NENs was 62.87±13.86 years,with identical distribution between genders(P=0.095).Both groups were predominantly white and married.There were a large number of patients with well differentiation in rectal group(27.8%),while colon group were mostly poorly differentiation(22.7%),and there was a statistically significant difference between these two groups(P<0.001).Most of patients of in rectal group were in stage?(79.2%),while most of patients in colon group were in stage?and?(80.0%),and the difference was significant(P<0.001). The 10-year cancer-specific survival rates of stage?,?,?,?patients were 98.9%,81.8%,59.0%,12.2%,respectively(P<0.001).Univariate analysis showed that age(?~2=654.928;P<0.001),sex(?~2=6.431;P=0.011),race(?~2=292.506;P<0.001),marital status(?~2=302.750;P<0.001),primary tumor site(?~2=1620.403;P<0.001),grade(?~2=4197.195;P<0.001),stage(?~2=6515.961;P<0.001)andsurgery(?~2=1241.452;P<0.001)were associated with prognosis.Multivariate Cox analysis showed that age(HR=1.604,95%CI:1.431~1.799;P<0.001),sex(HR=0.823,95%CI:0.738~0.918);P<0.001),marital status(HR=1.095,95%CI:1.036~1.157;P=0.001),primary tumor site(HR=1.212,95%CI:1.058~1.389;P=0.006)and grade(HR=1.85,95%CI:1.721~1.935;P<0.001),stage(HR=3.429,95%CI:3.115~3.776;P<0.001)and surgery(HR=1.451,95%CI:1.263~1.664;P<0.001)except race(HR=0.991,95%CI:0.90~1.092;P=0.857)were independent factors affecting patients survival. The overall survival rates of patients of rectal NENs(86.8%)was significant higher than that of colon NENs(44.8%).In multivariate analysis of patients with different stages,the survival of rectal NENs in stage?,?and?were higher than those of corresponding stage of colon NENs,but worse in stage?(stage?:HR:4.184,95%CI:1.718~10.190,P=0.002;stage?:HR:1.679,95%CI:1.036~2.724,P=0.036;stage?:HR:0.723,95%CI:0.561~0.932,P=0.012;stage?:HR:1.141,95%CI:1.012~1.287,P=0.031).While the survival of rectal NENs were significantly higher than those of colon NENs within all stages when excluding the patients of cecum NENs(stage?:HR:4.946,95%CI:2.025~12.083,P<0.001;stage?:HR:2.306,95%CI:1.335~3.982,P=0.003;stage?:HR:1.340,95%CI:1.016~1.767,P=0.038;stage?:HR:1.565,95%CI:1.372~1.784,P<0.001).Of the patients with high differentiated NENs,multivariate analysis indicated that the survival of rectal NENs in stage?,?and?were better than those of corresponding stage of colon NENs(stage?:HR:9.615,95%CI:1.760~52.533,P=0.009;stage?:HR:2.464,95%CI:1.123~5.404,P=0.024;stage?:HR:1.709,95%CI:1.040~2.809,P=0.034)while there was no significant difference for stage?(stage?:HR:3.470,95%CI:0.589~20.439,P=0.169).For low differentiated NENs,only the survival of rectal NENs patients in stage?was significant longer than those of corresponding colon NENs(HR:1.394,95%CI:1.154~1.683,P=0.001),while there were no significant difference for stage?,?and?(stage?:HR:0.658,95%CI:0.045~9.609,P=0.760;stage?:HR:0.566,95%CI:0.246~1.304,P=0.181;stage?:HR:0.824,95%CI:0.566~1.200,P=0.313).Conclusions1.The number of patients with rectal NENs was significantly more than that of patients with colon NENs.As compared with rectal NENs,colon NENs often presented advanced grade and stage,with extensive metastatic diseases at diagnosis.2.The survival of rectal NENs was superior to that of colon NENs.3.Age,sex,marital status,primary tumor site,grade,stage and surgery were associated with prognosis.4.Cecum NENs should be considered as a separated tumor location for prognostic analysis due to its special clinicopathologic characteristics.5.The survival of patients with low differentiated NENs may be impacted by chemotherapy regimens. |
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