Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2021; 27(7): 624-640
Published online Feb 21, 2021. doi: 10.3748/wjg.v27.i7.624
Clinicopathological features and prognostic factors associated with gastroenteropancreatic mixed neuroendocrine non-neuroendocrine neoplasms in Chinese patients
Yu-Chen Huang, Ning-Ning Yang, Hong-Chun Chen, Yuan-Li Huang, Wen-Tian Yan, Ru-Xue Yang, Nan Li, Shan Zhang, Pan-Pan Yang, Zhen-Zhong Feng
Yu-Chen Huang, Ning-Ning Yang, Hong-Chun Chen, Yuan-Li Huang, Wen-Tian Yan, Nan Li, Zhen-Zhong Feng, Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
Yu-Chen Huang, Ning-Ning Yang, Hong-Chun Chen, Yuan-Li Huang, Wen-Tian Yan, Nan Li, Zhen-Zhong Feng, Department of Pathology, Bengbu Medical College, Bengbu 233000, Anhui Province, China
Ru-Xue Yang, Department of Pathology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
Shan Zhang, Department of Pathology, The Second People's Hospital of Hefei, Hefei 230000, Anhui Province, China
Pan-Pan Yang, Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
Author contributions: Huang YC collected the clinical data and prepared the manuscript; Huang YC and Yang NN designed the study and supervised the statistical data; Huang YC and Chen HC designed the research and contributed to the analyses; Huang YL, Yan WT, Yang RX, Li N, Zhang S, and Yang PP provided clinical advice; Feng ZZ made the pathologic diagnosis and supervised the report.
Supported by The Natural Science Foundation of Anhui Province, No. 1908085MH275; the Key Project of Science and Technology Development Foundation of Bengbu Medical College, No. BYKF201710; and the Graduate Innovation Program of Bengbu Medical College, No. Byycx20064.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Bengbu Medical College.
Informed consent statement: All patients provided written informed consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Zhen-Zhong Feng, PhD, Professor, Department of Pathology, First Affiliated Hospital of Bengbu Medical College, No. 287 Changhuai Road, Longzihu District, Bengbu 233000, Anhui Province, China. fzz18297301626@163.com
Received: November 15, 2020
Peer-review started: November 15, 2020
First decision: December 17, 2020
Revised: December 24, 2020
Accepted: January 13, 2021
Article in press: January 13, 2021
Published online: February 21, 2021
BACKGROUND
The incidence of mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) is low. To improve our understanding of this rare tumor type and optimally guide clinical treatment, associated risk factors, clinical manifestations, and prognosis must be explored.
AIM
To identify risk factors that influence the prognosis of patients with gastroenteropancreatic MiNEN (GEP-MiNEN).
METHODS
We retrospectively analyzed the clinical data of 46 patients who were diagnosed with GEP-MiNEN at the First Affiliated Hospital of Bengbu Medical College (Anhui, China) between January 2013 and December 2017. Risk factors influencing the prognosis of the patients were assessed using Kaplan-Meier curves and cox regression models. We compared the results with 55 randomly selected patients with gastroenteropancreatic GEP neuroendocrine tumors, 47 with neuroendocrine carcinomas (NEC), and 58 with poorly differentiated adenocarcinoma.
RESULTS
Among the 46 patients with GEP-MiNEN, thirty-five had gastric tumors, nine had intestinal tumors (four in the small intestine and five in the colon and rectum), and two had pancreatic tumors. The median age of the patients was 66 (41-84) years, and the male-to-female ratio was 2.83. Thirty-three (71.7%) patients had clinical stage III and IV cancers. Distant metastasis occurred in 14 patients, of which 13 had metastasis to the liver. The follow-up period was 11-72 mo, and the median overall survival was 30 mo. Ki-67 index ≥ 50%, high proportion of NEC, lymph node involvement, distant metastasis, and higher clinical stage were independent risk factors affecting the prognosis of patients with GEP-MiNEN. The median overall survival was shorter for patients with NEC than for those with MiNEN (14 mo vs 30 mo, P = 0.001), but did not significantly differ from those with poorly differentiated adenocarcinoma and MiNEN (30 mo vs 18 mo, P = 0.453).
CONCLUSION
A poor prognosis is associated with rare, aggressive GEP-MiNEN. Ki-67 index, tumor composition, lymph node involvement, distant metastasis, and clinical stage are important factors for patient prognosis.
Core Tip: A poor prognosis is associated with gastroenteropancreatic mixed neuroendocrine-non-neuroendocrine neoplasms, a rare, aggressive type of tumor. Ki-67 index, tumor composition, lymph node involvement, distant metastasis, and clinical stage are important factors for patient prognosis.
