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Survival in Patients with High-Grade Colorectal Neuroendocrine Carcinomas: The Role of Surgery and Chemotherapy

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Colorectal neuroendocrine tumors are a rare malignancy, yet their incidence appears to be increasing. The optimal treatment for the high-grade subset of these tumors remains unclear. We aimed to examine the relationship between different treatment modalities and outcomes for patients with high-grade neuroendocrine carcinomas (HGNECs) of the colon and rectum.

Methods

The National Cancer Database (2004–2015) was used to identify patients diagnosed with colorectal HGNECs. The primary outcome was overall survival. A Cox Proportional hazard model was used to identify risk factors for survival.

Results

Overall, 1208 patients had HGNECs; 452 (37.4%) patients had primary tumors of the rectum, and 756 (62.5%) patients had primary tumors of the colon. A total of 564 (46.7%) patients presented with stage IV disease. The median survival was 9.0 months [95% confidence interval (CI) 8.2–9.8]. In multivariable analysis, surgical resection [hazard ratio (HR) 0.54, 95% CI 0.44–0.66; p < 0.001], chemotherapy (HR 0.74, 95% CI 0.69–0.79; p < 0.001), and rectum as the primary site of tumor (HR 0.62, 95% CI 0.51–0.76; p < 0.001) were associated with better overall survival, while older age (HR 1.01, 95% CI 1.00–1.01; p = 0.02) and the presence of metastatic disease (HR 3.34, 95% CI 2.69–4.15; p < 0.001) were associated with worse survival.

Conclusions

Patients with colorectal HGNECs selected for chemotherapy and surgical resection of the primary tumor demonstrated better overall survival than those managed without resection. Patients who were able to undergo systemic chemotherapy may benefit from potentially curative resection of the primary tumor.

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Authors and Affiliations

  1. Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Adam C. Fields MD, Pamela Lu MD, Benjamin M. Vierra MS, Frances Hu MD, Jennifer Irani MD, Ronald Bleday MD, Joel E. Goldberg MD, MPH & Nelya Melnitchouk MD, MSc

  2. Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Pamela Lu MD & Nelya Melnitchouk MD, MSc

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Garrett M. Nash MD, MPH

Authors
  1. Adam C. Fields MD
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  2. Pamela Lu MD
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  3. Benjamin M. Vierra MS
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  4. Frances Hu MD
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  5. Jennifer Irani MD
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  6. Ronald Bleday MD
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  7. Joel E. Goldberg MD, MPH
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  8. Garrett M. Nash MD, MPH
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  9. Nelya Melnitchouk MD, MSc
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Contributions

All authors made substantial contributions to the design of the work, drafted the work, approved the final version submitted for publication, and agreed to be accountable for all aspects of the work.

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Correspondence to Adam C. Fields MD or Nelya Melnitchouk MD, MSc.

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Adam C. Fields and Pamela Lu MD were co-first authors on this work.

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Fields, A.C., Lu, P., Vierra, B.M. et al. Survival in Patients with High-Grade Colorectal Neuroendocrine Carcinomas: The Role of Surgery and Chemotherapy. Ann Surg Oncol 26, 1127–1133 (2019). https://doi.org/10.1245/s10434-019-07203-3

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  • DOI: https://doi.org/10.1245/s10434-019-07203-3

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