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©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
ARTICLE HIGHLIGHTS
Research background
Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) are a rare tumor type. However, their prevalence might be largely underestimated due to diagnostic limitations and insufficient scientific understanding. The clinical manifestations, treatment, and prognosis of this type of tumor are still poorly understood. Our research on the risk factors, clinical manifestations, and prognosis related to this rare tumor type is of great significance for optimizing clinical treatment.
Research motivation
MiNEN associated risk factors, clinical manifestations, and prognosis must be explored to improve our understanding of this rare tumor type and optimize clinical treatment.
Research objectives
We have identified the risk factors that influence the prognosis of patients with gastroenteropancreatic MiNEN (GEP-MiNEN). We also compared prognostic differences between GEP-MiNEN and gastroenteropancreatic neuroendocrine tumors, neuroendocrine carcinomas (NEC), and poorly differentiated adenocarcinoma to improve the understanding of GEP-MiNEN and to guide future clinical treatment.
Research methods
This is a single-center, retrospective study. We retrospectively analyzed the clinical data of patients who were diagnosed with GEP-MiNEN. Risk factors influencing patient prognosis were assessed using Kaplan-Meier curves and Cox regression models. We compared the results with randomly selected patients with gastro-enteropancreatic neuroendocrine tumors, NEC, and poorly differentiated adeno-carcinomas.
Research results
Most GEP-MiNEN in our study were gastric tumors, a few were intestinal tumors, and a minority, pancreatic tumors. 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 but did not significantly differ from those with poorly differentiated adenocarcinoma and MiNEN. Thus, patients with GEP-MiNEN and those with adenocarcinoma should be similarly treated. Furthermore, the treatment of any suspected or diagnosed GEP-MiNEN patient should be discussed at a multidisciplinary expert meeting to determine optimal personalized treatment. However, the number of patients in the present retrospective study was limited by the rarity of GEP-MiNEN, and they were sourced from a single institution. Therefore, further multicenter, larger-cohort studies are warranted to clarify the clinicopathological features and biological behavior of GEP-MiNEN.
Research conclusions
A poor prognosis is associated with GEP-MiNEN. Ki-67 index, tumor composition, lymph node involvement, distant metastasis, and clinical stage are important factors for patient prognosis.
Research perspectives
In view of the limited number of patients and the short-term follow-up of our study, a larger prospective study with long-term follow-up is needed to confirm our results.
