TY - JOUR
T1 - Prognosis for Poorly Differentiated, High-Grade Rectal Neuroendocrine Carcinomas
AU - Erstad, Derek J.
AU - Dasari, Arvind
AU - Taggart, Melissa W.
AU - Kaur, Harmeet
AU - Konishi, Tsuyoshi
AU - Bednarski, Brian K.
AU - Chang, George J.
N1 - Publisher Copyright:
© 2021, Society of Surgical Oncology.
PY - 2022/4
Y1 - 2022/4
N2 - Introduction: Rectal neuroendocrine carcinomas (rNECs) are poorly characterized and, given their aggressive nature, optimal management is not well-established. We therefore sought to describe clinicopathologic traits, treatment details, and survival patterns for patients with rNECs. Methods: Patients captured in the National Cancer Database (NCDB; 2004–2016) with rNECs managed with observation, chemotherapy, or proctectomy ± chemotherapy were considered for analysis. Results: The inclusion criteria were met by 777 patients. Mean age was 62.4 years, 45% were male, 80% were Caucasian, 40% presented with lymph nodes metastases, and 49% presented with distant metastases. Chemotherapy and surgical resection were administered in 72 and 19% of cases, respectively. Median overall survival (OS) was 0.83 years (1 year, 41%; 3 years, 13%; 5 years, 10%). During the study interval, 659 (85%) patients died, with a median follow-up of 0.79 years. On multivariable analysis, age ≥60 years, male sex, and distant metastases were associated with worse survival; surgical resection and administration of chemotherapy were associated with a reduced risk of death. Among non-metastatic patients treated with surgical resection, administration of chemotherapy was protective, while a positive lymph node ratio (LNR) ≥42% (median value) was associated with an increased risk of death. There was no difference in the number of examined lymph nodes between LNR cohorts. Conclusions: Patients with rNECs experience dismal survival outcomes, including those with non-metastatic disease treated with curative-intent surgical resection. Neoadjuvant therapy can serve as a useful biologic test, and surgical resection should be judiciously employed.
AB - Introduction: Rectal neuroendocrine carcinomas (rNECs) are poorly characterized and, given their aggressive nature, optimal management is not well-established. We therefore sought to describe clinicopathologic traits, treatment details, and survival patterns for patients with rNECs. Methods: Patients captured in the National Cancer Database (NCDB; 2004–2016) with rNECs managed with observation, chemotherapy, or proctectomy ± chemotherapy were considered for analysis. Results: The inclusion criteria were met by 777 patients. Mean age was 62.4 years, 45% were male, 80% were Caucasian, 40% presented with lymph nodes metastases, and 49% presented with distant metastases. Chemotherapy and surgical resection were administered in 72 and 19% of cases, respectively. Median overall survival (OS) was 0.83 years (1 year, 41%; 3 years, 13%; 5 years, 10%). During the study interval, 659 (85%) patients died, with a median follow-up of 0.79 years. On multivariable analysis, age ≥60 years, male sex, and distant metastases were associated with worse survival; surgical resection and administration of chemotherapy were associated with a reduced risk of death. Among non-metastatic patients treated with surgical resection, administration of chemotherapy was protective, while a positive lymph node ratio (LNR) ≥42% (median value) was associated with an increased risk of death. There was no difference in the number of examined lymph nodes between LNR cohorts. Conclusions: Patients with rNECs experience dismal survival outcomes, including those with non-metastatic disease treated with curative-intent surgical resection. Neoadjuvant therapy can serve as a useful biologic test, and surgical resection should be judiciously employed.
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U2 - 10.1245/s10434-021-11016-8
DO - 10.1245/s10434-021-11016-8
M3 - Article
C2 - 34787737
AN - SCOPUS:85119212623
SN - 1068-9265
VL - 29
SP - 2539
EP - 2548
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 4
ER -