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

https://arctichealth.org/en/permalink/ahliterature118405
Source
Ann Surg Oncol. 2013 Apr;20(4):1170-8
Publication Type
Article
Date
Apr-2013
Author
Ryaz Chagpar
Yi-Ju Chiang
Yan Xing
Janice N Cormier
Barry W Feig
Asif Rashid
George J Chang
Y Nancy You
Author Affiliation
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Source
Ann Surg Oncol. 2013 Apr;20(4):1170-8
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Aged
Colonic Neoplasms - classification - mortality - pathology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Grading
Neoplasm Invasiveness
Neoplasm Metastasis
Neoplasm Staging - standards
Neuroendocrine Tumors - classification - mortality - secondary
Prognosis
Rectal Neoplasms - classification - mortality - pathology
Registries
Survival Rate
Abstract
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.
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.
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.
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.
PubMed ID
23212760 View in PubMed
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