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Poorer prognosis for neuroendocrine carcinoma than signet ring cell cancer of the colon and rectum (CRC-NEC): a propensity score matching analysis of patients from the Surveillance, Epidemiology, and End Results (SEER) database

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Colorectal neuroendocrine carcinomas (CRC-NECs) are rare, comprising < 1% of colorectal cancers. This study aimed to assess the incidence, clinicopathologic characteristics, prognostic factors, and treatment outcomes of CRC-NEC.

Methods

We analysed the Surveillance, Epidemiology, and End Results (SEER) database to identify patients from 20 to 74 years old diagnosed with CRC-NEC or common CRC (non-NEC) during 2004–2013. Log-rank testing was conducted to assess survival differences. A competing-risks regression model was used to adjust for covariate effects in the propensity score-matched (PSM) cohort, and adjusted hazard ratios (HRs) were calculated for the raw and PSM cohorts.

Results

We identified 67,484 patients (344 CRC-NEC and 67,140 non-NEC). Lymph node metastasis (LNM) was more common in CRC-NEC (75.29%, n = 259) than in non-NEC (51.53%, n = 34,600) (P < 0.001); 56.40% (n = 194) of CRC-NECs were located on the right side, while 18.31% (n = 63) were located on the left side, with a statistically significant difference in distribution (P < 0.001) compared to that in non-NEC CRC. Multivariate analysis indicated that a left-side location was an independent adverse prognostic factor for CRC-NEC (P = 0.043). CRC-NEC had the poorest cancer-specific survival (median CSS, 9.0 months) among assessed cancers, even poorer than that of signet ring cell cancer (median CSS, 24.0 months). However, both radical operation (P = 0.007) and chemotherapy (P = 0.008) were beneficial for CSS.

Conclusion

NEC is a rare and extremely aggressive tumour with a poor prognosis. Right-side NEC has a better prognosis than left-side NEC. Early diagnosis, radical surgery, and chemotherapy are imperative for improving survival.

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Data availability

All the raw data were obtained from the publicly available SEER database with no special permission needed.

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Acknowledgements

The authors appreciate the efforts of the Surveillance, Epidemiology, and End Results (SEER) Program tumour registries in the creation of the SEER database and the Data Management team who generously spared their time for the accomplishment and fulfilment of this project.

Funding

The study was partially supported by a grant from the Key Program of the Jinhua Municipal Science & Technology Bureau (grant number 2018-3-001d). This study was supported by a grant from the Key Program of Scientific Research of Jinhua Central Hospital (grant number JY2016-1-02). The study was partially supported by the Medical Science & Technology Plan Project of Zhejiang Province (grant number LGF18H160029) and the General Program of Zhejiang Natural Science Foundation (grant number LY19H160020). The study was partially supported by a grant from the Key Program of the Jinhua Municipal Science & Technology Bureau (grant number 2019-3-013).

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Authors and Affiliations

  1. Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, 310014, Zhejiang Province, China

    Youwei Chen & Jiangfeng Tu

  2. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, 351 Mingyue Road, Jinhua, 321000, Zhejiang Province, China

    Shishi Zhou, Jianfei Fu & Qinghua Wang

Authors
  1. Youwei Chen
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  2. Jiangfeng Tu
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  3. Shishi Zhou
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  5. Qinghua Wang
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Contributions

Design of the study and drafting the manuscript: Youwei Chen. Acquisition of data, collection, and review of the literature: Jiangfeng Tu and Shishi Zhou. Critical revision of the manuscript for important content: Qinghua Wang and Jianfei Fu.

Corresponding authors

Correspondence to Jianfei Fu or Qinghua Wang.

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The authors declare that they have no competing interests.

Ethics approval and consent to participate

The study was approved by the institutional review board and ethics committee of Affiliated Jinhua Hospital, Zhejiang University School of Medicine. All individual records were anonymous and de-identified prior to analysis.

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The authors declare that they have no conflicts of interest to disclose, and all agree with the publication in International Journal of Colorectal Disease.

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Chen, Y., Tu, J., Zhou, S. et al. Poorer prognosis for neuroendocrine carcinoma than signet ring cell cancer of the colon and rectum (CRC-NEC): a propensity score matching analysis of patients from the Surveillance, Epidemiology, and End Results (SEER) database. Int J Colorectal Dis 36, 745–756 (2021). https://doi.org/10.1007/s00384-020-03809-2

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