PRIMARY COLORECTAL NEUROENDOCRINE TUMORS: CLINICO-PATHOLOGIC CHARACTERISTICS AND SURVIVAL, A SINGLE INSTITUTION’S EXPERIENCE OVER 10 YEARS.
AACE ePoster Library. Duma N. 05/13/15; 97774; 711
Dr. Narjust Duma
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Abstract
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Introduction: Neuroendocrine tumors (NETs) are neoplasms of enterochromaffin cell origin; these neoplasms are often slow-growing and can cause a variety of nonspecific symptoms. The annual incidence of NET is 8.4 per 100,000; yet many of these tumors remain asymptomatic and are often found after metastasis has occurred. The aim of this study was to investigate the clinical characteristics and predictors of survival in primary colorectal NETs.
Methods: We reviewed the records of all patients (pts) diagnosed with colorectal NET at our institution from 2000 to 2013. Demographics, tumor characteristics, recurrence and survival were analyzed. Kaplan-Meier and Cox regression were used for survival and multivariate analysis.
Results: A total of 27 pts with primary colorectal NET were identified. Mean age at diagnosis was 61 years (23-86). There was a higher prevalence in females than males (67% vs. 33%, p<0.03). The most common initial presentations were: gastrointestinal bleeding (28%), weight loss (20%) or abdominal pain (11%). Our pts were more likely to have recto-sigmoidal tumors than all other tumor locations combined (71% vs. 29%, p<0.006). Only 36% of the NETs were >2cm in diameter. Regarding histologic grade, 74% were poorly differentiated vs. 26% were well to moderately differentiated tumors (p<0.001). At diagnosis, 55% (15) of the pts were stage IV; with liver (68%) representing the most common site of distant metastasis. 63% of the pts underwent surgery with 47% of the pts having positive margins after resection. Median overall survival was 58 months (95%CI: 37-78). There was a significant difference in survival upon tumor location, being 74 months for recto-sigmoidal tumors (95%CI: 47-102) and 38 months for right-sided tumors (95%CI: 12-63), p<0.03. Female gender (OR: 0.14, p<0.02), negative margins (OR: 0.18, p<0.04) and tumor location (0.41, p<0.0001) were independent predictors of survival by multivariate analysis. In 59% (16) of the pts, this cancer was the primary cause of death.
Discussion: In our cohort, we observed that colorectal NETs are very aggressive malignancies, as evidence by 55% presenting at stage IV and being the primary cause of death in 59% of the pts. Tumor location was a detrimental factor in survival. Overall, right sided tumors survival was 35 months less when compared with recto-sigmoidal tumors. This difference in survival could be explained by the early onset of symptoms in recto-sigmoidal tumors, due to decreased left colonic diameter.
Conclusions: Presentation of NETS tends to be very unspecific, making diagnosis in an early stage a challenge. Further research should aim to elucidate the basis of these differences, as this could impact management and improve survival.
Methods: We reviewed the records of all patients (pts) diagnosed with colorectal NET at our institution from 2000 to 2013. Demographics, tumor characteristics, recurrence and survival were analyzed. Kaplan-Meier and Cox regression were used for survival and multivariate analysis.
Results: A total of 27 pts with primary colorectal NET were identified. Mean age at diagnosis was 61 years (23-86). There was a higher prevalence in females than males (67% vs. 33%, p<0.03). The most common initial presentations were: gastrointestinal bleeding (28%), weight loss (20%) or abdominal pain (11%). Our pts were more likely to have recto-sigmoidal tumors than all other tumor locations combined (71% vs. 29%, p<0.006). Only 36% of the NETs were >2cm in diameter. Regarding histologic grade, 74% were poorly differentiated vs. 26% were well to moderately differentiated tumors (p<0.001). At diagnosis, 55% (15) of the pts were stage IV; with liver (68%) representing the most common site of distant metastasis. 63% of the pts underwent surgery with 47% of the pts having positive margins after resection. Median overall survival was 58 months (95%CI: 37-78). There was a significant difference in survival upon tumor location, being 74 months for recto-sigmoidal tumors (95%CI: 47-102) and 38 months for right-sided tumors (95%CI: 12-63), p<0.03. Female gender (OR: 0.14, p<0.02), negative margins (OR: 0.18, p<0.04) and tumor location (0.41, p<0.0001) were independent predictors of survival by multivariate analysis. In 59% (16) of the pts, this cancer was the primary cause of death.
Discussion: In our cohort, we observed that colorectal NETs are very aggressive malignancies, as evidence by 55% presenting at stage IV and being the primary cause of death in 59% of the pts. Tumor location was a detrimental factor in survival. Overall, right sided tumors survival was 35 months less when compared with recto-sigmoidal tumors. This difference in survival could be explained by the early onset of symptoms in recto-sigmoidal tumors, due to decreased left colonic diameter.
Conclusions: Presentation of NETS tends to be very unspecific, making diagnosis in an early stage a challenge. Further research should aim to elucidate the basis of these differences, as this could impact management and improve survival.
Introduction: Neuroendocrine tumors (NETs) are neoplasms of enterochromaffin cell origin; these neoplasms are often slow-growing and can cause a variety of nonspecific symptoms. The annual incidence of NET is 8.4 per 100,000; yet many of these tumors remain asymptomatic and are often found after metastasis has occurred. The aim of this study was to investigate the clinical characteristics and predictors of survival in primary colorectal NETs.
Methods: We reviewed the records of all patients (pts) diagnosed with colorectal NET at our institution from 2000 to 2013. Demographics, tumor characteristics, recurrence and survival were analyzed. Kaplan-Meier and Cox regression were used for survival and multivariate analysis.
Results: A total of 27 pts with primary colorectal NET were identified. Mean age at diagnosis was 61 years (23-86). There was a higher prevalence in females than males (67% vs. 33%, p<0.03). The most common initial presentations were: gastrointestinal bleeding (28%), weight loss (20%) or abdominal pain (11%). Our pts were more likely to have recto-sigmoidal tumors than all other tumor locations combined (71% vs. 29%, p<0.006). Only 36% of the NETs were >2cm in diameter. Regarding histologic grade, 74% were poorly differentiated vs. 26% were well to moderately differentiated tumors (p<0.001). At diagnosis, 55% (15) of the pts were stage IV; with liver (68%) representing the most common site of distant metastasis. 63% of the pts underwent surgery with 47% of the pts having positive margins after resection. Median overall survival was 58 months (95%CI: 37-78). There was a significant difference in survival upon tumor location, being 74 months for recto-sigmoidal tumors (95%CI: 47-102) and 38 months for right-sided tumors (95%CI: 12-63), p<0.03. Female gender (OR: 0.14, p<0.02), negative margins (OR: 0.18, p<0.04) and tumor location (0.41, p<0.0001) were independent predictors of survival by multivariate analysis. In 59% (16) of the pts, this cancer was the primary cause of death.
Discussion: In our cohort, we observed that colorectal NETs are very aggressive malignancies, as evidence by 55% presenting at stage IV and being the primary cause of death in 59% of the pts. Tumor location was a detrimental factor in survival. Overall, right sided tumors survival was 35 months less when compared with recto-sigmoidal tumors. This difference in survival could be explained by the early onset of symptoms in recto-sigmoidal tumors, due to decreased left colonic diameter.
Conclusions: Presentation of NETS tends to be very unspecific, making diagnosis in an early stage a challenge. Further research should aim to elucidate the basis of these differences, as this could impact management and improve survival.
Methods: We reviewed the records of all patients (pts) diagnosed with colorectal NET at our institution from 2000 to 2013. Demographics, tumor characteristics, recurrence and survival were analyzed. Kaplan-Meier and Cox regression were used for survival and multivariate analysis.
Results: A total of 27 pts with primary colorectal NET were identified. Mean age at diagnosis was 61 years (23-86). There was a higher prevalence in females than males (67% vs. 33%, p<0.03). The most common initial presentations were: gastrointestinal bleeding (28%), weight loss (20%) or abdominal pain (11%). Our pts were more likely to have recto-sigmoidal tumors than all other tumor locations combined (71% vs. 29%, p<0.006). Only 36% of the NETs were >2cm in diameter. Regarding histologic grade, 74% were poorly differentiated vs. 26% were well to moderately differentiated tumors (p<0.001). At diagnosis, 55% (15) of the pts were stage IV; with liver (68%) representing the most common site of distant metastasis. 63% of the pts underwent surgery with 47% of the pts having positive margins after resection. Median overall survival was 58 months (95%CI: 37-78). There was a significant difference in survival upon tumor location, being 74 months for recto-sigmoidal tumors (95%CI: 47-102) and 38 months for right-sided tumors (95%CI: 12-63), p<0.03. Female gender (OR: 0.14, p<0.02), negative margins (OR: 0.18, p<0.04) and tumor location (0.41, p<0.0001) were independent predictors of survival by multivariate analysis. In 59% (16) of the pts, this cancer was the primary cause of death.
Discussion: In our cohort, we observed that colorectal NETs are very aggressive malignancies, as evidence by 55% presenting at stage IV and being the primary cause of death in 59% of the pts. Tumor location was a detrimental factor in survival. Overall, right sided tumors survival was 35 months less when compared with recto-sigmoidal tumors. This difference in survival could be explained by the early onset of symptoms in recto-sigmoidal tumors, due to decreased left colonic diameter.
Conclusions: Presentation of NETS tends to be very unspecific, making diagnosis in an early stage a challenge. Further research should aim to elucidate the basis of these differences, as this could impact management and improve survival.
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