Background
Methods
Patients and data collection
Grading and staging classification
Statistical analysis
Results
Comparison of the clinical characteristics of SI-NENs in different races
Characteristics | Chinese Patients (N = 277) | SEER database |
P value | ||
---|---|---|---|---|---|
White patients (N = 6711) | Black patients (N = 1387) | Asian/Pacific Islander Patients (N = 217) | |||
Age, years | <0.001 | ||||
Mean(95%CI) | 54.4 (52.8–56.0) | 62.4 (62.0–62.7) | 60.3 (59.6–61.0) | 60.7 (59.0–62.5) | |
Range | 17–83 | 2–98 | 21–96 | 27–95 | |
Sex | <0.001 | ||||
Male | 157 (56.7%) | 3448 (51.4%) | 635 (45.8%) | 116 (53.5%) | |
Female | 120 (43.3%) | 3263 (48.6%) | 752 (54.2%) | 101 (46.5%) | |
Location of primary tumora
| <0.001 | ||||
Duodenum | 212b (76.5%) | 1541 (31.9%) | 569 (57.5%) | 123 (71.9%) | |
ampulla | 72 (37.1%) | 117 (7.6%) | 24 (4.2%) | 9 (7.3%) | |
Non-ampulla | 122 (62.9%) | 1424 (92.4%) | 545 (95.8%) | 114 (92.7%) | |
Jejunum/ileum | 65 (23.5%) | 3283 (68.1%) | 420 (42.5%) | 48 (28.1%) | |
Presenting Symptoms | - | ||||
Abdominal pain | 152 (54.9%) | ||||
Nausea/vomiting | 48 (17.3%) | ||||
Bloating | 42 (15.2%) | ||||
Jaundice | 37 (13.4%) | ||||
GI bleeding | 34 (12.3%) | ||||
Diarrhea | 27 (9.7%) | ||||
Intestinal obstruction | 24 (8.7%) | ||||
Flushing | 9 (3.2%) | ||||
Incidental diagnosis | - | ||||
Yes | 35 (12.6%) | ||||
No (symptomatic) | 242 (87.4%) | ||||
Tumor sizec
| <0.001 | ||||
Median (cm) | 2.5 | 1.6 | 1.5 | 1.5 | |
Tumor graded
| - | ||||
Grade 1 | 91 (36.5%) | ||||
Grade 2 | 81 (32.5%) | ||||
Grade 3 | 77 (30.9%) | ||||
Tumor differentiatione
| 0.095f
| ||||
Well differentiated | 2324 (76.6%) | 474 (81.3%) | 69 (74.2%) | ||
Moderately differentiated | 553 (18.2%) | 84 (14.4%) | 15 (16.1%) | ||
Poorly differentiated/undifferentiated | 157 (5.2%) | 25 (4.3%) | 9 (9.7%) | ||
Tumor stageg
| <0.001h
| ||||
I | 32 (13.3%) | 626 (13.2%) | 162 (18.3%) | 43 (25.4%) | |
II | 88 (36.5%) | 709 (15.0%) | 186 (21.0%) | 28 (16.6%) | |
III | 61 (25.3%) | 2077 (43.8%) | 331 (37.4%) | 59 (34.9%) | |
IV | 60 (24.9%) | 1329 (28.0%) | 205 (23.2%) | 39 (23.1%) | |
Location of distant metastasesi
| - | ||||
No | 217 (78.3%) | ||||
Liver | 52 (86.7%) | ||||
Bone | 3 (5.0%) | ||||
Lung | 1 (1.7%) | ||||
Brain | 1 (1.7%) | ||||
Others | 13 (21.7%) | ||||
Surgery of primary tumor | - | ||||
Performed | 233 (84.1%) | 5787 (86.2%) | 1097 (79.1%) | 166 (76.5%) | |
Unperformed or unknown | 44 (15.9%) | 924 (13.8%) | 290 (20.9%) | 51 (23.5%) |
Comparison of duodenal and jejunal/ileal NENs
Chinese Patients | White patients | Black patients | Asian/Pacific Islander patients | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Duodenum | Jejunum/ileum | P | Duodenum | Jejunum/ileum | P | Duodenum | Jejunum/ileum | P | Duodenum | Jejunum/ileum | P | |
Age, years | 0.452 | <0.001 | <0.001 | 0.157 | ||||||||
Mean | 54.7 | 53.3 | 63.3 | 60.7 | 62.7 | 57.2 | 62.5 | 59.2 | ||||
95%CI | 52.9–56.6 | 50.1–56.50 | 62.6–64.0 | 60.2–61.1 | 61.7–63.8 | 56.1–58.3 | 60.0–65.0 | 55.6–62.8 | ||||
Sex | 0.041 | 0.914 | 0.559 | 0.527 | ||||||||
Male | 113 (53.3%) | 44 (67.7%) | 763 (49.5%) | 1631 (49.7%) | 264 (46.4%) | 187 (44.5%) | 60 (48.8%) | 26 (54.2%) | ||||
Female | 99 (46.7%) | 21 (32.3%) | 778 (50.5%) | 1652 (50.3%) | 305 (53.6%) | 233 (55.5%) | 63 (51.2%) | 22 (45.8%) | ||||
Tumor size, cm | <0.001 | <0.001 | <0.001 | 0.001 | ||||||||
Median | 2.0 | 3.0 | 1.0 | 1.9 | 1.0 | 1.9 | 1.0 | 1.5 | ||||
Tumor gradea
| 191b
| 58c
| 0.227 | - | - | - | ||||||
Grade 1 | 74 (38.7%) | 17 (29.3%) | ||||||||||
Grade 2 | 57 (29.8%) | 24 (41.4%) | ||||||||||
Grade 3 | 60 (31.4%) | 17 (29.3%) | ||||||||||
Tumor differentiation | - | 658d
| 1647e
| <0.001 | 223f
| 202g
| 0.149 | 47h
| 21i
| 0.232 | ||
Well differentiated | 497 (75.5%) | 1268 (77.0%) | 171 (76.7%) | 169 (83.7%) | 38 (80.9%) | 14 (66.7%) | ||||||
Moderately differentiated | 98 (14.9%) | 321 (19.5%) | 43 (19.3%) | 25 (12.4%) | 4 (8.5%) | 5 (23.8%) | ||||||
Poorly or undifferentiated | 63 (9.6%) | 58 (3.5%) | 9 (4.0%) | 8 (4.0%) | 5 (10.6%) | 2 (9.5%) | ||||||
T status | 169b
| 53c
| <0.001 | 890d
| 2559e
| <0.001 | 300f
| 339g
| <0.001 | 72h
| 38i
| <0.001 |
T1 | 34 (20.1%) | 3 (5.7%) | 497 (55.8%) | 283 (11.1%) | 165 (55.0%) | 33 (9.7%) | 34 (47.2%) | 5 (13.2%) | ||||
T2 | 67 (39.6%) | 9 (17.0%) | 279 (31.3%) | 584 (22.8%) | 109 (36.3%) | 102 (30.1%) | 27 (37.5%) | 9 (23.7%) | ||||
T3 | 56 (33.1%) | 35 (66.0%) | 62 (7.0%) | 1044 (40.8%) | 17 (5.7%) | 128 (37.8%) | 6 (8.3%) | 14 (36.8%) | ||||
T4 | 12 (7.1%) | 6 (11.3%) | 52 (5.8%) | 648 (25.3%) | 9 (3.0%) | 76 (22.4%) | 5 (6.9%) | 10 (26.3%) | ||||
N status | 188b
| 59c
| <0.001 | 1332d
| 3146e
| <0.001 | 479f
| 401g
| <0.001 | 109h
| 47i
| <0.001 |
N0 | 127 (67.6%) | 22 (37.3%) | 1154 (86.6%) | 930 (29.6%) | 421 (87.9%) | 142 (35.4%) | 94 (86.2%) | 15 (31.9%) | ||||
N1 | 61 (32.4%) | 37 (62.7%) | 178 (13.4%) | 2216 (70.4%) | 58 (12.1%) | 259 (64.6%) | 15 (13.8%) | 32 (68.1%) | ||||
M status | 212b
| 65c
| 0.090 | 1308d
| 2672e
| <0.001 | 458f
| 353g
| <0.001 | 119h
| 48i
| <0.001 |
M0 | 171 (80.7%) | 46 (70.8%) | 1217 (93.0%) | 1908 (71.4%) | 434 (94.8%) | 267 (75.6%) | 112 (94.1%) | 36 (75.0%) | ||||
M1 | 41 (19.3%) | 19 (29.2%) | 91 (7.0%) | 764 (28.6%) | 24 (5.2%) | 86 (24.4%) | 7 (5.9%) | 12 (25.0%) | ||||
Tumor stage | 183b
| 58c
| <0.001 | 817d
| 2548e
| <0.001 | 273f
| 330g
| <0.001 | 76h
| 47i
| <0.001 |
I | 30 (16.4%) | 2 (3.4%) | 407 (49.8%) | 132 (5.2%) | 134 (49.1%) | 16 (4.8%) | 34 (44.7%) | 5 (10.6%) | ||||
II | 75 (41.0%) | 13 (22.4%) | 190 (23.3%) | 305 (12.0%) | 75 (27.5%) | 53 (16.1%) | 20 (26.3%) | 7 (14.9%) | ||||
III | 37 (20.2%) | 24 (41.4%) | 129 (15.8%) | 1347 (52.9%) | 40 (14.7%) | 175 (53.0%) | 15 (19.7%) | 23 (48.9%) | ||||
IV | 41 (22.4%) | 19 (32.8%) | 91 (11.1%) | 764 (30.0%) | 24 (8.8%) | 86 (26.1%) | 7 (9.2%) | 12 (25.5%) |
Comparison of ampullary and non-ampullary duodenal NENs
Characteristics | Chinese patients | White patients | Black patients | ||||||
---|---|---|---|---|---|---|---|---|---|
Ampullary NENs | Non-ampullary duodenal NENs | P | Ampullary NENs | Non-ampullary duodenal NENs | P | Ampullary NENs | Non-ampullary duodenal NENs | P | |
Age, years | 0.961 | 0.003 | 0.028 | ||||||
Mean (95%CI) | 54.9 (51.9–58.0) | 54.8 (52.3–57.4) | 59.7 (57.1–62.3) | 63.6 (62.9–64.3) | 57.1 (52.5–61.7) | 63.0 (61.9–64.0) | |||
Range | 25–81 | 17–80 | 31–87 | 13–97 | 34–80 | 21–94 | |||
Sex | 72a
| 122b
| 0.337 | 117c
| 1424d
| 0.691 | 24e
| 545f
| 0.435 |
Male | 35 (48.6%) | 68 (55.7%) | 60 (51.3%) | 703 (49.4%) | 13 (54.2%) | 251 (46.1%) | |||
Female | 37 (51.4%) | 54 (44.3%) | 57 (48.7%) | 721 (50.6%) | 11 (45.8%) | 294 (53.9%) | |||
Tumor size, cm | 61a
| 93b
| 0.010 | 86c
| 851d
| <0.001 | 21e
| 312f
| <0.001 |
Median | 2.5 | 1.6 | 1.8 | 0.9 | 2.2 | 1.0 | |||
Presenting Symptoms | 72a
| 122b
| - | - | - | ||||
Abdominal pain | 34 (47.2%) | 63 (51.6%) | |||||||
Jaundice | 26 (36.1%) | 7 (5.7%) | <0.001g
| ||||||
Nausea/vomiting | 8 (11.1%) | 17 (13.9%) | |||||||
Bloating | 5 (6.9%) | 23 (18.9%) | |||||||
GI bleeding | 8 (11.1%) | 16 (13.1%) | |||||||
Diarrhea | 3 (4.2%) | 11 (9.0%) | |||||||
Intestinal obstruction | 4 (5.6%) | 3 (2.5%) | |||||||
Flushing | 2 (2.8%) | 2 (1.6%) | |||||||
Incidental diagnosis | 72a
| 122b
| 0.386 | ||||||
Yes | 8 (11.1%) | 19 (15.6%) | |||||||
No (symptomatic) | 64 (88.9%) | 103 (84.4%) | |||||||
Tumor grade | 63a
| 112b
| 0.003 | - | - | ||||
Grade 1 | 18 (28.6%) | 48 (42.9%) | |||||||
Grade 2 | 15 (23.8%) | 39 (34.8%) | |||||||
Grade 3 | 30 (47.6%) | 25 (22.3%) | <0.001 | 0.177 | |||||
Tumor differentiation | - | 63c
| 595d
| 15e
| 209f
| ||||
Well differentiated | 28 (44.4%) | 469 (78.8%) | 10 (66.7%) | 161 (77.0%) | |||||
Moderately differentiated | 12 (19.0%) | 86 (14.5%) | 3 (20.0%) | 40 (19.1%) | |||||
Poorly or undifferentiated | 23 (36.5%) | 40 (6.7%) | 2 (13.3%) | 8 (3.8%) | |||||
T status | 60a
| 95b
| <0.001 | 78c
| 812d
| <0.001 | 19e
| 281f
| 0.002 |
T1 | 4 (6.7%) | 29 (30.5%) | 15 (19.2%) | 482 (59.4%) | 3 (15.8%) | 162 (57.7%) | |||
T2 | 20 (33.3%) | 39 (41.1%) | 39 (50.0%) | 240 (29.6%) | 13 (68.4%) | 96 (34.2%) | |||
T3 | 30 (50.0%) | 21 (22.1%) | 9 (11.5%) | 53 (6.5%) | 2 (10.5%) | 15 (5.3%) | |||
T4 | 6 (10.0%) | 6 (6.3%) | 15 (19.2%) | 37 (4.6%) | 1 (5.3%) | 8 (2.8%) | |||
N status | 70a
| 102b
| 0.535 | 97c
| 1235d
| <0.001 | 22e
| 457f
| <0.001 |
N0 | 47 (67.1%) | 73 (71.6%) | 51 (52.6%) | 1103 (89.3%) | 13 (59.1%) | 408 (89.3%) | |||
N1 | 23 (32.9%) | 29 (28.4%) | 46 (47.4%) | 132 (10.7%) | 9 (40.9%) | 49 (10.7%) | |||
M status | 72a
| 122b
| 0.071 | 110c
| 1198d
| <0.001 | 22e
| 436f
| 0.001 |
M0 | 64 (88.9%) | 96 (78.7%) | 87 (79.1%) | 1130 (94.3%) | 17 (77.3%) | 417 (95.6%) | |||
M1 | 8 (11.1%) | 26 (21.3%) | 23 (20.9%) | 68 (5.7%) | 5 (22.7%) | 19 (4.4%) | |||
Tumor stage | 64a
| 102b
| <0.001 | 90c
| 727d
| <0.001 | 20e
| 253f
| 0.005 |
I | 3 (4.7%) | 26 (25.5%) | 8 (8.9%) | 399 (54.9%) | 3 (15.0%) | 131 (51.8%) | |||
II | 30 (46.9%) | 39 (38.2%) | 16 (17.8%) | 174 (23.9%) | 8 (40.0%) | 67 (26.5%) | |||
III | 23 (35.9%) | 11 (10.8%) | 43 (47.8%) | 86 (11.8%) | 4 (20.0%) | 36 (14.2%) | |||
IV | 8 (12.5%) | 26 (25.5%) | 23 (25.6%) | 68 (9.4%) | 5 (25.0%) | 19 (7.5%) |
Tumor grade and survival
Factor (N) | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
2% as threshold | 5% as threshold | |||||
HR (95% CI) | P | HR (95% CI) | P | HR (95% CI) | P | |
Age (207) | 1.02 (0.99–1.04) | 0.204 | ||||
Sex | 0.502 | |||||
Male (121) | 1.00 | |||||
Female (86) | 0.82 (0.45–1.48) | |||||
Location of primary tumor | ||||||
Ampulla (54) | 1.00 | |||||
Non-ampulla duodenum (106) | 0.69 (0.35–1.34) | 0.272 | ||||
Jejunum/ileum (47) | 0.62 (0.29–1.34) | 0.223 | ||||
Tumor stage | 0.002 | 0.022 | 0.033 | |||
Stage I/II (95) | 1.00 | 1.00 | 1.00 | |||
Stage III (44) | 2.43 (1.01–5.87) | 0.048 | 1.89 (0.78–4.58) | 0.158 | 1.90 (0.79–4.61) | 0.155 |
Stage IV (48) | 4.68 (2.13–10.27) | <0.001 | 3.44 (1.55–7.62) | 0.002 | 3.29 (1.48–7.31) | 0.003 |
Unknown (20) | 2.90 (1.03–8.15) | 0.044 | 2.26 (0.80–6.37) | 0.124 | 2.17 (0.77–6.13) | 0.144 |
Ki-67 index | <0.001 | <0.001 | ||||
≤ 2% (80) | 1.00 | 1.00 | ||||
3%–20% (63) | 2.67 (0.82–8.68) | 0.102 | 2.18 (0.66–7.15) | 0.199 | ||
> 20% (64) | 14.73 (5.20–41.74) | <0.001 | 12.21 (4.26–34.98) | <0.001 | ||
Ki-67 index | <0.001 | <0.001 | ||||
≤ 5% (118) | 1.00 | 1.00 | ||||
6%–20% (25) | 4.29 (1.44–12.76) | 0.009 | 3.28 (1.08–9.98) | 0.036 | ||
> 20% (64) | 12.98 (5.70–29.56) | <0.001 | 11.31 (4.92–26.01) | <0.001 |