Abstract
Background
With the rapid advances in endoscopic technology, endoscopic therapy (ET) is increasingly applied to the treatment of small (≤ 20 mm) colorectal neuroendocrine tumors (NETs). However, long-term data comparing ET and surgery for management of T1N0M0 colorectal NETs are lacking. The purpose of this work was to compare overall survival (OS) and cancer-specific survival (CSS) of such patients with ET or surgery.
Methods
Patients with T1N0M0 colorectal NETs were identified within the Surveillance Epidemiology and End Results (SEER) database (2004–2016). Demographics, tumor characteristics, therapeutic methods, and survival were compared. Propensity score matching (PSM) was used 1:3 and among this cohort, Cox proportional hazards regression models were performed to evaluate correlation between treatment and outcomes.
Results
Of 4487 patients with T1N0M0 colorectal NETs, 1125 were identified in the matched cohort, among whom 819 (72.8%) underwent ET and 306 (27.2%) underwent surgery. There was no difference in the 5-year and 10-year OS and CSS rates between the 2 treatment modalities. Likewise, analyses stratified by tumor size and site showed that patients did not benefit more from surgery compared with ET. Moreover, multivariate analyses found no significant differences in OS [Hazard Ratio (HR) = 0.857, 95% Confidence Interval (CI): 0.513–1.431, P = 0.555] and CSS (HR = 0.925, 95% CI: 0.282–3.040, P = 0.898) between the 2 groups. Similar results were observed when comparisons were limited to patients with different tumor size and site.
Conclusions
In this population-based study, patients with lesions < 10 mm treated endoscopically had comparable long-term survival compared with those treated surgically, which demonstrates ET as an alternative to surgery in T1N0M0 colorectal NETs of < 10 mm. Further high-quality prospective studies are warranted to comprehensively evaluate the role of ET in patients with tumors 10 to 20 mm.
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Data availability
The data were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database. This is an open database. (https://seer.cancer.gov).
Abbreviations
- ET:
-
Endoscopic therapy
- NETs:
-
Neuroendocrine tumors
- OS:
-
Overall survival
- CSS:
-
Cancer-specific survival
- SEER database:
-
Surveillance Epidemiology and End Results database
- PSM:
-
Propensity score matching
- HR:
-
Hazard Ratio
- 95% CI:
-
95% Confidence Interval
- NCCN:
-
National Comprehensive Cancer Network
- NCI:
-
National Cancer Institute, AJCC: American Joint Committee on Cancer
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Acknowledgements
We would like to thank the researchers and study participants for their contributions.
Funding
This research work was supported by the Key Medical Talents of Jiangsu Province (Grant No. ZDRCA2016034) (to LM).
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HLZ, SZ and KJ designed the study. HLZ and WW performed data mining. JZ and CMZ analyzed the data. HLZ, SZ and RYT drafted the initial manuscript. KJ, LLY, HHY and LM contributed to the revision of the manuscript. All authors read and approved the final manuscript.
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Hanlong Zhu, Si Zhao, Chunmei Zhang, Kun Ji, Wei Wu, Linlin Yin, Haihao Yan, Jian Zhou, Ruiyi Tang and Lin Miao have declared that they have no conflicts of interest or financial ties to disclose.
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464_2021_8535_MOESM1_ESM.png
Supplementary file1 Kaplan-Meier survival curves comparing endoscopic therapy and surgery for entire cohort before propensity matching. (A) Overall survival; (B) Cancer-specific survival. (PNG 48 KB)
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Zhu, H., Zhao, S., Zhang, C. et al. Endoscopic and surgical treatment of T1N0M0 colorectal neuroendocrine tumors: a population-based comparative study. Surg Endosc 36, 2488–2498 (2022). https://doi.org/10.1007/s00464-021-08535-6
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DOI: https://doi.org/10.1007/s00464-021-08535-6