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Neuroendocrine tumors of the colon and rectum: prognostic relevance and comparative performance of current staging systems.

Abstract：

BACKGROUND:With increasing interest in neuroendocrine tumors (NETs), three staging systems for NETs of the colon and rectum have been published. Their prognostic relevance has not been examined and compared in an independent clinical database. METHODS:From the National Cancer Database (NCDB), 5457 patients diagnosed with colorectal neuroendocrine tumor (CRNETs) between 1998 and 2002 were staged according to the staging systems from (1) European Neuroendocrine Tumor Society (ENETS, 2006; n = 1537); (2) American Joint Committee on Cancer (AJCC, 2009; n = 1140); and (3) location-specific staging systems from the Surveillance Epidemiology and End Results (SEER, 2008; n = 942). Stage-stratified overall survival (OS) and Cox-specific concordance indices were calculated for each system. Independent prognostic factors were identified by multivariate analysis. RESULTS:Five-year OS for stage I, II, III, and IV CRNETs as defined by the ENETS staging system were 90.8, 77.3, 53.1, and 14.8 %, respectively. For well-differentiated CRNETs, the 5-year OS for stage I, II, III, and IV as defined by the AJCC staging system were superior: 90.6, 83.9, 64.8, and 24.9 %, respectively. Both staging systems had a concordance index of 0.72. After specifying location in the colon versus rectum, all three systems demonstrated acceptable performance. Histologic grade was a significant independent predictor of OS not currently incorporated in the staging systems. CONCLUSIONS:The three staging systems showed comparable prognostic stratification of CRNETs, while the AJCC and ENETS systems are the most parsimonious. The current analysis supports the use of the AJCC for well-differentiated disease and ENETS systems for all CRNETs until there is further evidence for modification.

journal_name

Ann Surg Oncol

journal_title

Annals of surgical oncology

authors

Chagpar R,Chiang YJ,Xing Y,Cormier JN,Feig BW,Rashid A,Chang GJ,You YN

doi

10.1245/s10434-012-2746-z

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

1170-8

issue

eissn

1068-9265

issn

1534-4681

journal_volume

pub_type

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Neuroendocrine tumors of the colon and rectum: prognostic relevance and comparative performance of current staging systems.