Survival and Prognostic Factor Analysis of 146 Metastatic Neuroendocrine Tumors of the Mid-GutStrosberg J. · Gardner N. · Kvols L.
H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla., USA
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: Gastrointestinal neuroendocrine tumors (NETs) are heterogeneous neoplasms that vary in mortality according to location of primary tumor and stage of disease. Past analyses of survival suggest a trend towards improving longevity among patients with metastatic mid-gut NETs. Methods: We evaluated all cases of metastatic NETs of the mid-gut seen in our institution between 1999 and 2003, measuring survival from time of diagnosis of distant metastatic disease. Median and 5-year survival rates were estimated using Kaplan-Meier methodology. We assessed the impact of various prognostic factors including age, gender, hepatic cytoreductive surgery, and operative resection of the primary tumor. Results: 146 cases of metastatic mid-gut NETs were identified. The median overall survival was 103 months and the 5-year survival rate was 75%. Most patients (91%) received octreotide therapy. Other medical treatments included hepatic artery embolization, chemotherapy, and peptide receptor radiotherapy. Primary tumor resection was performed in 69% of cases, and hepatic cytoreductive surgery in 22% of cases. A median survival of 95 months was observed among patients who did not undergo cytoreductive surgery. Operative resection of the primary tumor was not associated with a significant survival advantage. Conclusions: Median overall survival is 103 months (8.5 years) in patients with metastatic mid-gut NETs. Among patients who are not candidates for hepatic cytoreductive surgery, median survival is 95 months (7.9 years). Resection of the primary tumor does not appear to be associated with a survival benefit in the metastatic setting.
© 2009 S. Karger AG, Basel
- Modlin IM, Lye KD, Kidd M: A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934–959.
- Shebani KO, Souba WW, Finkelstein DM, et al: Prognosis and survival in patients with gastrointestinal tract carcinoid tumors. Ann Surg 1999;229:815–821; discussion 822–823.
- Pape UF, Bohmig M, Berndt U, et al: Survival and clinical outcome of patients with neuroendocrine tumors of the gastroenteropancreatic tract in a German referral center. Ann N Y Acad Sci 2004;1014:222–233.
- Rorstad O: Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract. J Surg Oncol 2005;89:151–160.
- Burke AP, Thomas RM, Elsayed AM, Sobin LH: Carcinoids of the jejunum and ileum: an immunohistochemical and clinicopathologic study of 167 cases. Cancer 1997;79:1086–1093.
- Godwin JD 2nd: Carcinoid tumors. An analysis of 2,837 cases. Cancer 1975;36:560–569.
- Janson ET, Holmberg L, Stridsberg M, et al: Carcinoid tumors: analysis of prognostic factors and survival in 301 patients from a referral center. Ann Oncol 1997;8:685–690.
- McDermott EW, Guduric B, Brennan MF: Prognostic variables in patients with gastrointestinal carcinoid tumours. Br J Surg 1994;81:1007–1009.
- Maggard MA, O’Connell JB, Ko CY: Updated population-based review of carcinoid tumors. Ann Surg 2004;240:117–122.
- Modlin IM, Sandor A: An analysis of 8305 cases of carcinoid tumors. Cancer 1997;79:813–829.
- Moertel CG, Sauer WG, Dockerty MB, Baggenstoss AH: Life history of the carcinoid tumor of the small intestine. Cancer 1961;14:901–912.
- Olney JR, Urdaneta LF, Al-Jurf AS, et al: Carcinoid tumors of the gastrointestinal tract. Am Surg 1985;51:37–41.
- Williams ED, Sandler M: The classification of carcinoid tumours. Lancet 1963;1:238–239.
- Que FG, Nagorney DM, Batts KP, et al: Hepatic resection for metastatic neuroendocrine carcinomas. Am J Surg 1995;169:36–42; discussion 42–43.
- Norton JA, Warren RS, Kelly MG, et al: Aggressive surgery for metastatic liver neuroendocrine tumors. Surgery 2003;134:1057–1063; discussion 1063–1065.
- Osborne DA, Zervos EE, Strosberg J, et al: Improved outcome with cytoreduction versus embolization for symptomatic hepatic metastases of carcinoid and neuroendocrine tumors. Ann Surg Oncol 2006;13:572–581.
- Sarmiento JM, Que FG: Hepatic surgery for metastases from neuroendocrine tumors. Surg Oncol Clin N Am 2003;12:231–242.
- McEntee GP, Nagorney DM, Kvols LK, et al: Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 1990;108:1091–1096.
- Givi B, Pommier SJ, Thompson AK, et al: Operative resection of primary carcinoid neoplasms in patients with liver metastases yields significantly better survival. Surgery 2006;140:891–897; discussion 897–898.
- Boudreaux JP, Putty B, Frey DJ, et al: Surgical treatment of advanced-stage carcinoid tumors: lessons learned. Ann Surg 2005;241:839–845; discussion 845–846.
- Hellman P, Lundstrom T, Ohrvall U, et al: Effect of surgery on the outcome of midgut carcinoid disease with lymph node and liver metastases. World J Surg 2002;26:991–997.
- Moller JE, Pellikka PA, Bernheim AM, et al: Prognosis of carcinoid heart disease: analysis of 200 cases over two decades. Circulation 2005;112:3320–3327.
- Kvols LK, Moertel CG, O’Connell MJ, et al: Treatment of the malignant carcinoid syndrome. Evaluation of a long-acting somatostatin analogue. N Engl J Med 1986;315:663–666.
- Arnold R, Trautmann ME, Creutzfeldt W, et al: Somatostatin analogue octreotide and inhibition of tumour growth in metastatic endocrine gastroenteropancreatic tumours. Gut 1996;38:430–438.
- Lamberts SW, van der Lely AJ, de Herder WW, Hofland LJ: Octreotide. N Engl J Med 1996;334:246–254.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.