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Tsunokake J, Fujishima F, Watanabe H, Sato I, Miura K, Sakamoto K, Suzuki H, Sawai T, Itakura Y, Hoshi T, Kunimitsu A, Yamauchi T, Akaishi R, Ozawa Y, Fukutomi T, Okamoto H, Sato C, Taniyama Y, Kamei T, Sasano H. Tumor Microenvironment in Mixed Neuroendocrine Non-Neuroendocrine Neoplasms: Interaction between Tumors and Immune Cells, and Potential Effects of Neuroendocrine Differentiation on the Tumor Microenvironment. Cancers (Basel) 2022; 14:2152. [DOI: doi.org/10.3390/cancers14092152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
The tumor microenvironment is considered to play a pivotal role in various human malignancies. Neuroendocrine and non-neuroendocrine neoplasms are considered to have different tumor microenvironments. However, owing to differences in the systemic and/or local immune statuses, tumor microenvironments in different patients may be difficult to compare. Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs), although rare, could be useful for exploring the effects of neuroendocrine differentiation on the tumor microenvironment, because both neuroendocrine and non-neuroendocrine components are present in the same tumor. Here, we examined 33 cases of histologically confirmed MiNENs and evaluated the influence of neuroendocrine differentiation on the tumor microenvironment by comparing tumor-infiltrating lymphocytes, tumor-associated macrophages, and other relevant factors in the two components the same tumor. The immunoreactivity of those examined above was evaluated quantitatively. The values of vasohibin-1-positive density (p < 0.0001) and immunoreactivity (p < 0.0001) (representing the neoangiogenesis status) were significantly higher in neuroendocrine as compared to non-neuroendocrine areas of the same tumors. In addition, the Foxp3/CD8 (p = 0.0717) and the PD-1/CD8 ratios (p = 0.0176) (representing tumor immunity suppression) tend to increase in neuroendocrine carcinomas. Immunoreactivity of CD163, a marker of M2-like macrophages, was also higher in the neuroendocrine areas. Our findings indicate that neuroendocrine and non-neuroendocrine tumors differ from each other with respect to the characteristics of both tumor cells and the tumor microenvironment.
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Tsunokake J, Fujishima F, Watanabe H, Sato I, Miura K, Sakamoto K, Suzuki H, Sawai T, Itakura Y, Hoshi T, Kunimitsu A, Yamauchi T, Akaishi R, Ozawa Y, Fukutomi T, Okamoto H, Sato C, Taniyama Y, Kamei T, Sasano H. Tumor Microenvironment in Mixed Neuroendocrine Non-Neuroendocrine Neoplasms: Interaction between Tumors and Immune Cells, and Potential Effects of Neuroendocrine Differentiation on the Tumor Microenvironment. Cancers (Basel) 2022; 14:cancers14092152. [PMID: 35565281 PMCID: PMC9100554 DOI: 10.3390/cancers14092152] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/16/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022] Open
Abstract
The tumor microenvironment is considered to play a pivotal role in various human malignancies. Neuroendocrine and non-neuroendocrine neoplasms are considered to have different tumor microenvironments. However, owing to differences in the systemic and/or local immune statuses, tumor microenvironments in different patients may be difficult to compare. Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs), although rare, could be useful for exploring the effects of neuroendocrine differentiation on the tumor microenvironment, because both neuroendocrine and non-neuroendocrine components are present in the same tumor. Here, we examined 33 cases of histologically confirmed MiNENs and evaluated the influence of neuroendocrine differentiation on the tumor microenvironment by comparing tumor-infiltrating lymphocytes, tumor-associated macrophages, and other relevant factors in the two components the same tumor. The immunoreactivity of those examined above was evaluated quantitatively. The values of vasohibin-1-positive density (p < 0.0001) and immunoreactivity (p < 0.0001) (representing the neoangiogenesis status) were significantly higher in neuroendocrine as compared to non-neuroendocrine areas of the same tumors. In addition, the Foxp3/CD8 (p = 0.0717) and the PD-1/CD8 ratios (p = 0.0176) (representing tumor immunity suppression) tend to increase in neuroendocrine carcinomas. Immunoreactivity of CD163, a marker of M2-like macrophages, was also higher in the neuroendocrine areas. Our findings indicate that neuroendocrine and non-neuroendocrine tumors differ from each other with respect to the characteristics of both tumor cells and the tumor microenvironment.
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Affiliation(s)
- Junichi Tsunokake
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
- Department of Pathology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (F.F.); (H.W.); (H.S.)
- Correspondence: ; Tel.: +81-22-717-7440
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (F.F.); (H.W.); (H.S.)
| | - Hirofumi Watanabe
- Department of Pathology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (F.F.); (H.W.); (H.S.)
| | - Ikuro Sato
- Department of Pathology, Miyagi Cancer Center, Natori 981-1293, Japan;
| | - Koh Miura
- Department of Surgery, Miyagi Cancer Center, Natori 981-1293, Japan;
| | - Kazuhiro Sakamoto
- Department of Pathology, Osaki Citizen Hospital, Osaki 989-6183, Japan;
| | - Hiroyoshi Suzuki
- Department of Pathology, Sendai Medical Center, Sendai 983-8520, Japan;
| | - Takashi Sawai
- Department of Pathology, Sendai Open Hospital, Sendai 983-0824, Japan;
| | - Yuko Itakura
- Department of Pathology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 986-8522, Japan;
| | - Tatsuya Hoshi
- Department of Internal Medicine, Kesennuma Citizen Hospital, Kesennuma 988-0181, Japan;
| | - Atsushi Kunimitsu
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
- Department of Pathology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (F.F.); (H.W.); (H.S.)
| | - Takuro Yamauchi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
| | - Ryujiro Akaishi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
| | - Yohei Ozawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
| | - Toshiaki Fukutomi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
| | - Hiroshi Okamoto
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
| | - Chiaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
| | - Yusuke Taniyama
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (A.K.); (T.Y.); (R.A.); (Y.O.); (T.F.); (H.O.); (C.S.); (Y.T.); (T.K.)
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (F.F.); (H.W.); (H.S.)
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Grossi U, Bonis A, Carrington EV, Mazzobel E, Santoro GA, Cattaneo L, Centonze G, Gallo G, Kazemi Nava A, Romano M, Di Tanna GL, Zanus G. Mixed adenoneuroendocrine carcinoma (MANEC) of the lower gastrointestinal tract: A systematic review with Bayesian hierarchical survival analysis. Eur J Surg Oncol 2021; 47:2893-2899. [PMID: 34052038 DOI: 10.1016/j.ejso.2021.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/25/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mixed adeno-neuroendocrine carcinomas (MANEC) are a subgroup of mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) described as mixed neoplasms containing dual neuroendocrine and non-neuroendocrine components. The aim of this study was to appraise the prevalence of MANEC in the lower gastrointestinal (GI) tract and provide reliable estimates of survival. METHOD A systematic review was undertaken in accordance with PRISMA guidelines using PubMed, Embase, Cochrane Library of Systematic Review, Web of Science, and Scopus databases, and a Bayesian hierarchical survival pooled analysis was performed. RESULTS Of 182 unique records identified, 71 studies reporting on 752 patients met the inclusion criteria. Mean age was 64.2 ± 13.6, with a male-to-female ratio of 1.25. Overall, 60.3% of MANEC were located in the appendix, 29.3% in the colon, and 10.4% in the anorectum. More than a quarter (29%) of patients had stage IV disease at diagnosis, with higher prevalence in appendiceal than colonic and anorectal primaries. More than 80% had a high-grade (G3) endocrine component. Of the 152 patients followed up for a median of 20 months (interquartile range limits, 16.5-32), median overall survival was 12.3 months (95% credible interval [95%CrI], 11.3-13.7), with a 1.12 [95%CrI, 0.67-1.83] age-adjusted hazard ratio between metastatic and non-metastatic MANEC. Stage IV disease at diagnosis was more prognostically unfavorable in cases of colonic compared to anorectal origin. CONCLUSION MANEC is a clinically aggressive pathological entity. The results of this study provide new insights for the understanding of tumor location within the lower GI tract and its prognosis in terms of overall survival.
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Affiliation(s)
- Ugo Grossi
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Italy.
| | - Alessandro Bonis
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Italy
| | - Emma V Carrington
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Enrico Mazzobel
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Italy
| | | | - Laura Cattaneo
- Department of Diagnostic Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Centonze
- Department of Diagnostic Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Andrea Kazemi Nava
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Italy
| | - Maurizio Romano
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Italy
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Giacomo Zanus
- 4th Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Italy
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Shi H, Qi C, Meng L, Yao H, Jiang C, Fan M, Pang S, Zhang Q, Lin R. Do neuroendocrine carcinomas and mixed neuroendocrine-non-neuroendocrine neoplasm of the gastrointestinal tract have the same prognosis? A SEER database analysis of 12,878 cases. Ther Adv Endocrinol Metab 2020; 11:2042018820938304. [PMID: 32670540 PMCID: PMC7338725 DOI: 10.1177/2042018820938304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/08/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Neuroendocrine carcinomas (NECs) and mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) in the gastrointestinal (GI) tract are both rare and malignant; however, it is unclear whether their prognosis is the same. METHODS In this cross-sectional study, a total of 12,878 patients with NEC or MiNEN in the GI tract were reviewed retrospectively by searching the Surveillance, Epidemiology, and End Results (SEER) program database. Next, we compared the characteristics and survival between patients with NEC or MiNEN and further analyzed the prognostic factors for the patients. RESULTS The data showed that patients with MiNEN had a worse prognosis as compared with patients with pure NEC in the small intestine (SI) and appendix, whereas there was no significant survival difference between NEC and MiNEN in the other parts of the GI system. On the whole, age ⩾55 years (p < 0.0001), male (p = 0.002), being diagnosed at TNM Stage II-IV (p < 0.0001) or not receiving surgical treatment (p < 0.0001) were the independent negative prognostic factors for NEC patients, whereas age ⩾55 years (p = 0.003), being diagnosed at TNM Stage III-IV (p < 0.001) or not receiving surgical treatment (p < 0.001) were identified as the independent negative prognostic factors for the MiNEN patients. Furthermore, when NECs or MiNENs were classified based on the primary tumor site, the results showed that the prognostic factors for NEC and MiNEN varied between the tumor sites. CONCLUSION The prognostic differences between NECs and MiNENs in the GI tract are heterogeneous and site-related. Patients with appendiceal or SI MiNEN have a poorer prognosis than patients with pure appendiceal or SI NEC. Therefore, we should pay more attention to patients with MiNEN in the SI and appendix and monitor them more closely.
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Affiliation(s)
| | | | - Lingjun Meng
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Hailing Yao
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Chen Jiang
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Mengke Fan
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Suya Pang
- Department of Gastroenterology, Union Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
| | - Qin Zhang
- Department of Pathology, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
China
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