Background:Neuroendocrine carcinomas (NECs) of the tubular gastrointestinal tract (GI-NECs) are rare and associated with worse clinical outcomes. This population-based study aims to highlight key demographics, clinicopathological factors, and survival outcomes in the US population.Methods:Data from 10,387 patients with GI-NECs were extracted from the Surveillance, Epidemiology, and End Result (SEER) database from 2000 to 2020.Results:Most patients were >40 years old at the time of presentation with a median age of 63 years old, with almost equal ethnic distribution per US population data. The most common primary tumor site was the small intestine (33.6%). The metastatic spread was localized in 34.8%, regional in 27.8%, and distant in 37.3% of cases, and the liver was the most common site of metastasis (19.9%) in known cases of metastases. Most NEC patients underwent surgery, presenting the highest 5-year overall survival of 73.2% with a 95% confidence interval (CI) (95% CI 72.0–74.4%), while chemotherapy alone had the lowest 5-year survival of 8.0% (95% CI 6.4–10.0%). Compared to men, women had a superior 5-year survival rate of 59.0% (95% CI 57.6–60.5%). On multivariate analysis, age > 65 (HR 2.49, 95% CI 2.36–2.54%,p≤ 0.001), distant metastasis (HR 2.57, 95% CI 2.52–2.62%,p≤ 0.001), tumor size > 4 mm (HR 1.98, 95%, CI 1.70–2.31%,p≤ 0.001), esophageal (HR 1.49, 95% CI 0.86–2.58%,p≤ 0.001), transverse colon (HR 1.95, 95% CI 1.15–3.33%,p≤ 0.01), descending colon (HR 2.12, 95% CI 1.12, 3.97%,p= 0.02) anorectal sites, and liver or lung metastases were associated with worse survival. Surgical intervention and tumors located in the small intestine or appendix showed a better prognosis.Conclusion:GI-NECs are a group of rare malignancies associated with a poor prognosis. Therefore, epidemiological studies analyzing national databases may be the best alternative to have a more comprehensive understanding of this condition, assess the impact of current practices, and generate prognosis tools.
背景：胃肠道神经内分泌癌（GI-NECs）较为罕见，且临床预后较差。本研究基于人群数据，旨在揭示美国GI-NECs患者的关键人口学特征、临床病理因素及生存结局。 方法：从2000年至2020年的美国监测、流行病学和最终结果（SEER）数据库中提取10,387例GI-NECs患者的数据进行分析。 结果：大多数患者就诊时年龄超过40岁，中位年龄为63岁，种族分布与美国人口数据基本一致。最常见的原发肿瘤部位为小肠（33.6%）。在转移分布方面，34.8%为局部转移，27.8%为区域转移，37.3%为远处转移；在已知转移病例中，肝脏是最常见的转移部位（19.9%）。多数NEC患者接受了手术治疗，其5年总生存率最高，为73.2%（95% CI 72.0–74.4%）；而单纯化疗患者的5年生存率最低，为8.0%（95% CI 6.4–10.0%）。与男性相比，女性的5年生存率更高，为59.0%（95% CI 57.6–60.5%）。多变量分析显示，年龄>65岁（HR 2.49，95% CI 2.36–2.54%，p≤0.001）、远处转移（HR 2.57，95% CI 2.52–2.62%，p≤0.001）、肿瘤大小>4 mm（HR 1.98，95% CI 1.70–2.31%，p≤0.001）、原发部位为食管（HR 1.49，95% CI 0.86–2.58%，p≤0.001）、横结肠（HR 1.95，95% CI 1.15–3.33%，p≤0.01）、降结肠（HR 2.12，95% CI 1.12–3.97%，p=0.02）或肛门直肠，以及肝或肺转移均与较差的生存率相关。手术治疗以及原发肿瘤位于小肠或阑尾则提示预后较好。 结论：GI-NECs是一组罕见且预后不良的恶性肿瘤。因此，基于国家数据库的流行病学研究可能是更全面了解该疾病、评估当前临床实践影响以及建立预后工具的最佳途径。
肿瘤(癌症)患者之家