TY - JOUR
T1 - High-grade neuroendocrine colorectal carcinomas
T2 - A retrospective study of 100 patients presented in part at the 2014 Gastrointestinal Cancers Symposium, San Francisco, CA.
AU - Conte, Bruno
AU - George, Ben
AU - Overman, Michael
AU - Estrella, Jeannelyn
AU - Jiang, Zhi Qin
AU - Mehrvarz Sarshekeh, Amir
AU - Ferrarotto, Renata
AU - Hoff, Paulo M.
AU - Rashid, Asif
AU - Yao, James C.
AU - Kopetz, Scott
AU - Dasari, Arvind
N1 - Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background Colorectal high-grade neuroendocrine carcinomas (HGNEC) are a rare but aggressive group of malignancies without standard management recommendations. Methods We retrospectively reviewed the records of 100 consecutive patients with histologically confirmed colorectal HGNEC diagnosed at MD Anderson Cancer Center between 1991 and 2013. Results In our cohort, most tumors (89%) were small cell carcinoma, and most (60%) involved the sigmoid or the anorectal regions. Sixty-four patients (64%) presented with metastatic disease at diagnosis. Striking epidemiological and clinical differences between those established in small cell lung cancer (SCLC) and our cohort were noted, including significantly lower rates of smoking and lower risk of bone, brain metastases. Over 30% of the tumors were found associated with an adenoma. Median overall survival (OS) of the cohort was 14.7 months, with 2-year and 5-year OS rates of 23% and 8%, respectively. In patients with localized disease, multimodality therapy was associated with a trend toward improved median OS (20.4 vs. 15.4 months; P =.08). Metastases at presentation (OS 20.63 vs. 8.7 months; localized vs metastatic disease at presentation; P <.001) and elevated lactate dehydrogenase levels were strongly associated with a worse outcome. Conclusion In comparison to SCLC, less than half of the patients with colorectal HGNEC have history of smoking; metastatic patterns are also different between the 2 cancers. Nevertheless, HGNEC also has an aggressive biology, with the rectum being the most common site of origin. For localized disease, a multimodality approach seems to be associated with better outcomes, while systemic chemotherapy is the mainstay of treatment for advanced disease.
AB - Background Colorectal high-grade neuroendocrine carcinomas (HGNEC) are a rare but aggressive group of malignancies without standard management recommendations. Methods We retrospectively reviewed the records of 100 consecutive patients with histologically confirmed colorectal HGNEC diagnosed at MD Anderson Cancer Center between 1991 and 2013. Results In our cohort, most tumors (89%) were small cell carcinoma, and most (60%) involved the sigmoid or the anorectal regions. Sixty-four patients (64%) presented with metastatic disease at diagnosis. Striking epidemiological and clinical differences between those established in small cell lung cancer (SCLC) and our cohort were noted, including significantly lower rates of smoking and lower risk of bone, brain metastases. Over 30% of the tumors were found associated with an adenoma. Median overall survival (OS) of the cohort was 14.7 months, with 2-year and 5-year OS rates of 23% and 8%, respectively. In patients with localized disease, multimodality therapy was associated with a trend toward improved median OS (20.4 vs. 15.4 months; P =.08). Metastases at presentation (OS 20.63 vs. 8.7 months; localized vs metastatic disease at presentation; P <.001) and elevated lactate dehydrogenase levels were strongly associated with a worse outcome. Conclusion In comparison to SCLC, less than half of the patients with colorectal HGNEC have history of smoking; metastatic patterns are also different between the 2 cancers. Nevertheless, HGNEC also has an aggressive biology, with the rectum being the most common site of origin. For localized disease, a multimodality approach seems to be associated with better outcomes, while systemic chemotherapy is the mainstay of treatment for advanced disease.
KW - Colon
KW - Metastasis
KW - Rectum
KW - Small cell carcinoma
KW - Smoking
KW - Survival
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U2 - 10.1016/j.clcc.2015.12.007
DO - 10.1016/j.clcc.2015.12.007
M3 - Article
C2 - 26810202
AN - SCOPUS:84955278739
SN - 1533-0028
VL - 15
SP - e1-e7
JO - Clinical colorectal cancer
JF - Clinical colorectal cancer
IS - 2
ER -