Surgery Prolongs Five-Year Survival for Nonmetastatic Colon Neuroendocrine Tumors

Abstract

Abstract Background: While treatment guidelines for colon neuroendocrine tumors recommend surgical intervention when feasible, evidence in the literature is limited for patients with nonmetastatic tumors. Objectives: This study assessed the efficacy of surgery in terms of five year survival for patients with nonmetastatic colon neuroendocrine tumors. Design: This was a retrospective cohort study. Patient and Methods: This study used the National Cancer Database (NCDB) which compiles data from 1500 + facilities accredited to the Commission on Cancer. Data from patients with histologically confirmed colon neuroendocrine tumors from 2007 to 2018 were collected. Other inclusion criteria were age more than 18 years, nonmetastatic, nonpalliative care, known surgery status/type, and chemotherapy status. The five year survival rates were assessed using Kaplan–Meier curves and multivariate adjusted Cox proportional hazards regression to analyze the efficacy of surgery for these tumors. In addition, sensitivity analyses were performed to determine the associations in patients with well differentiated and early stage (stage 1) tumors. Main Outcome Measure: The main outcome was five year overall survival. Sample Size: A total of 3,340 patients met the inclusion criteria from the NCDB. Results: The majority of patients received some form of surgery (95.8%), while fewer patients (4.3%) received nonsurgical treatment. Overall, patients were on average 61.5 ± 13.3 years old, female (54.3%), and majority white (77.7%). Five year survival rates were 65.5% for the no surgery group and 79.5% for the surgery group [Kaplan–Meier log rank, P < .0001]. Moreover, multivariate proportional hazards regression showed prolonged five year survival after surgery [adjusted hazards ratio (aHR) (95% confidence interval): 0.39 (0.28–0.54)]. In addition, all sensitivity analyses revealed prolonged survival of patients who underwent surgery. Conclusion: To our knowledge, this is the first study to assess survival for nonmetastatic colon neuroendocrine tumors using a national database. Limitations: This study was limited by retrospective review, potential selection bias from a registry, and missing data. Conflicts of Interest: None.