Advances in Clinical and Experimental Medicine
2016, vol. 25, nr 4, July-August, p. 719–724
Publication type: original article
Clinicopathological and Prognostic Analysis of Neuroendocrine Carcinoma of the Colorectum
1 Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University Henan Cancer Hospital, Zhengzhou, China
2 Department of Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
3 Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
Background. Neuroendocrine carcinoma of the colorectum is a kind of malignant tumor composed of neuroendocrine cells, with a unique hormone synthesis and secretory function. In recent years, more and more attention is being paid to this kind of tumor, with its high malignant potential, poor differentiation, high invasiveness and early metastasis.
Objectives. The aim of this study was to evaluate the clinicopathological characteristics and prognosis of neuroendocrine carcinoma of the colorectum.
Material and Methods. The clinical data on 49 patients treated for neuroendocrine carcinoma of the colorectum from January 1995 to January 2013 were retrospectively analyzed and relevant scientific literature was investigated.
Results. The study subjects included 34 males and 15 females, out of whom 27 patients underwent curative operations, while 18 underwent palliative resections and four others underwent biopsy. All 49 patients underwent adjuvant chemotherapy after operation. Of the 45 resection samples, vascular invasion was found in 33 patients (73.3%) and regional lymph node metastasis was found in 35 patients (77.8%). All the patients were followed up for a period of 3 to 68 months. The 1-year, 3-year and 5-year survival rates were 49.1%, 17.2% and 6.9%, respectively. The patients’ survival time was related to the tumor stage, vascular invasion and surgery type (radical or not), but not related to age, gender, tumor size or tumor location.
Conclusion. Neuroendocrine carcinoma of the colon lacked specific clinical manifestations, but showed a high degree of malignancy and a poor prognosis. Tumour stage, vascular invasion and surgery type (radical or not) were important factors influencing the prognosis.
colorectal neoplasms, neuroendocrine carcinoma, pathology, clinical, prognosis
- Aytac E, Ozdemir Y, Ozuner G: Long term outcomes of neuroendocrine carcinomas (high-grade neuroendocrine tumors) of the colon, rectum, and anal canal. J Visc Surg 2014, 151, 3–7.
- Karkouche R, Bachet JB, Sandrini J, Mitry E, Penna C, Côté JF, Blons H, Penault-Llorca F, Rougier P, Saint André JP, Emile JF: Colorectal neuroendocrine carcinomas and adenocarcinomas share oncogenic pathways. A clinico-pathologic study of 12 cases. Eur J Gastroenterol Hepatol 2012, 24, 1430–1437.
- Grassia R, Bodini P, Dizioli P, Staiano T, Iiritano E, Bianchi G, Buffoli F: Neuroendocrine carcinomas arising in ulcerative colitis: Coincidences or possible correlations? World J Gastroenterol 2009, 15, 4193–4195.
- Bernick PE, Klimstra DS, Shia J, Minsky B, Saltz L, Shi W, Thaler H, Guillem J, Paty P, Cohen AM, Wong WD: Neuroendocrine carcinomas of the colon and rectum. Dis Colon Rectum 2004, 47, 163–169.
- Grabowski P, Schönfelder J, Ahnert-Hilger G, Foss HD, Stein H, Berger G, Zeitz M, Scherübl H: Heterogeneous expression of neuroendocrine marker proteins in human undifferentiated carcinoma of the colon and rectum. Ann N Y Acad Sci 2004, 1014, 270–274.
- La Rosa S, Marando A, Furlan D, Sahnane N, Capella C: Colorectal poorly differentiated neuroendocrine carcinomas and mixed adenoneuroendocrine carcinomas: Insights into the diagnostic immunophenotype, assessment of methylation profile, and search for prognostic markers. Am J Surg Pathol 2012, 36, 601–611.
- Smith J, Reidy-Lagunes D: The management of extrapulmonary poorly differentiated (high-grade) neuroendocrine carcinomas. Semin Oncol 2013, 40, 100–108.
- Bosman FT, Cameiro F, Hruban RH, Theise ND: WHO classification of tumours of the digestive system [M]. Lyon: IARC, 2010.
- Lawrence B, Gustafsson BI, Chan A, Svejda B, Kidd M, Modlin IM: The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am 2011, 40, 1–18.
- Vardas K, Papadimitriou G, Chantziara M, Papakonstantinou A, Drakopoulos S: Mixed large cell neuroendocrine carcinoma with squamous cellcarcinoma of the rectum: Report of a rare case and review of the literature. Int J Surg Case Rep 2013, 4, 1076–1079.
- Shomura H, Nakano S, Akabane H, Inagaki M, Yanagida N, Shibaki T, Kudo T, Shonaka T, Orimo T, Oikawa F, Aiyama T: Two cases of neuroendocrine carcinoma of the rectum. Gan To Kagaku Ryoho 2011, 38, 2265–2267.
- Portale TR, Branca A, Pesce A, Puleo S: Neuroendocrine carcinoma of colon and rectum: A rare neoplasia with a poor prognosis. Minerva Chir 2012, 67, 283–284.
- Vilallonga R, Espín Basany E, López Cano M, Landolfi S, Armengol Carrasco M: Neuroendocrine carcinomas of the colon and rectum. A unit’s experience over six years. Rev Esp Enferm Dig 2008, 100, 11–16.
- Grabowski P, Schönfelder J, Ahnert-Hilger G, Foss HD, Heine B, Schindler I, Stein H, Berger G, Zeitz M, Scherübl H: Expression of neuroendocrine markers: A signature of human undifferentiated carcinoma of the colon and rectum. Virchows Arch 2002, 441, 256–263.
- Vergelí-Rojas JA, Santiago-Caraballo DL, Cáceres-Perkins W, Magno-Pagatzartundua P, Toro DH: Small cell neuroendocrine carcinoma of rectum with associated paraneoplastic syndrome: A case report. P R Health Sci J 2013, 32, 51–53.
- Massironi S, Sciola V, Peracchi M, Ciafardini C, Spampatti MP, Conte D: Neuroendocrine tumors of the gastroenteropancreatic system. World J Gastroenterol 2008, 14, 5377–5584.
- Sakata J, Wakai T, Shirai Y, Sakata E, Hasegawa G, Hatakeyama K: Humoral hypercalcemia complicating adenocarcinoma of the sigmoid colon: Report of a case. Surg Today 2005, 35, 692–695.
- Oshiro T, Yamamoto S: A case of endocrine carcinoma of the rectum. Jpn J Clin Oncol 2011, 41, 730.
- Crichlow L, Ikemire P, Goswami M, Bellows CF: Colonic large cell neuroendocrine carcinoma obscured by an initial diagnosis of diverticulitis. J La State Med Soc 2011, 163, 218, 220–222.
- Yildiz O, Ozguroglu M, Yanmaz T, Turna H, Serdengecti S, Dogusoy G: Gastroenteropancreatic neuroendocrine tumors: 10-year experience in a single center. Med Oncol 2010, 27, 1050–1056.
- Rindi G, Bordi C, La Rosa S, Solcia E, Delle Fave G: Gastroenteropancreatic (neuro)endocrine neoplasms: The histology report. Dig Liver Dis 2011, 43 Suppl 4, 356–360.
- Peracchi M, Gebbia C, Basilisco G, Quatrini M, Tarantino C, Vescarelli C, Massironi S, Conte D: Plasma chromogranin A in patients with autoimmune chronic atrophic gastritis, enterochromaffin-like cell lesions and gastric carcinoids. Eur J Endocrinol 2005, 152, 443–448.
- Sato K, Yokouchi Y, Saida Y, Ito S, Kitagawa T, Maetani I: A small cell neuroendocrine carcinoma of the rectum diagnosed by colorectal endoscopic submucosal dissection. J Gastrointestin Liver Dis 2012, 21, 128.
- Jukić Z, Limani R, Luci LG, Nikić V, Mijić A, Tomas D, Krušlin B: hGH and GHR expression in large cell neuroendocrine carcinoma of the colon and rectum. Anticancer Res 2012, 32, 3377–3381.
- Starzyńska T, Szawłowski A, Kos-Kudła B, Królicki L, Kunikowska J, Nasierowska-Guttmejer A, Rudzki S, Zgliczyński W; oraz Pozostali Uczestnicy Konferencji Okragłego Stołu: Neuroendocrine tumors of the colon – management guidelines (recommended by The Polish Network of Neuroendocrine Tumors). Endokrynol Pol 2008, 59, 97–104.
- Norton JA, Warren RS, Kelly MG, Zuraek MB, Jensen RT: Aggressive surgery for metastatic liver neuroendocrine tumors. Surgery 2003, 134, 1057–1063.
- Scherübl H, Jensen RT, Cadiot G, Stölzel U, Klöppel G: Management of early gastrointestinal neuroendocrine neoplasms. World J Gastrointest Endosc 2011, 3, 133–139.
- Sarmiento JM,Que FG: Hepatic surgery for metastases from neuroendocrine tumors. Surg Oncol Clin N Am 2003, 12, 231–242.
- Yabuki H, Suto T, Inoue K, Fujimoto H, Sato T, Ikeda E, Iizawa H: A case of colorectal neuroendocrine carcinoma effectively treated with bevacizumab+levofolinate+5-FU chemotherapy. Gan To Kagaku Ryoho 2012, 39, 1139–1142.
- Sorbye H, Welin S, Langer SW, Vestermark LW, Holt N, Osterlund P, Dueland S, Hofsli E, Guren MG, Ohrling K, Birkemeyer E, Thiis-Evensen E, Biagini M,Gronbaek H, Soveri LM, Olsen IH, Federspiel B, Assmus J, Janson ET, Knigge U: Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO G3): The NORDIC NEC study. Ann Oncol 2013, 24, 152–160.
- Miyamoto H, Kurita N, Nishioka M, Ando T, Tashiro T, Hirokawa M, Shimada M: Poorly differentiated neuroendocrine cell carcinoma of the rectum: Report of a case and literal review. J Med Invest 2006, 53, 317–320.
- Patta A, Fakih M: First-line cisplatin plus etoposide in high-grade metastatic neuroendocrine tumors of colon and rectum (MCRC NET): Review of 8 cases. Anticancer Res 2011, 31, 975–978.
- Kumarasinghe MP, Weng EK: Pathological features and their prognostic implications in colorectal endocrine cell tumours: A long-term follow-up study. Pathology 2005, 37, 204–210.