The Southwestern Surgical Congress
A proposed staging system for small bowel carcinoid tumors based on an analysis of 6,380 patients

https://doi.org/10.1016/j.amjsurg.2008.07.042Get rights and content

Abstract

Background

Little is known about the long-term prognosis of small bowel carcinoids because currently no staging system exists.

Methods

A search of the Surveillance, Epidemiology and End Results (SEER) database identified 6,380 patients with small bowel carcinoid tumors from 1977 to 2004. Patients were analyzed according to various clinicopathologic factors and a tumor (T1, T2, T3), lymph node (N0, N1), and metastasis (M0, M1) staging system was created according to these parameters.

Results

Among the 6,380 patients, 2,985 women and 3,395 men, with a median age of 66 years (range 14–98), the median tumor size was 1.9 cm (range .1–30 cm). Multivariate analysis demonstrated that age, size of the primary tumor, and depth of invasion were significant factors. Four stages were created according to statistically significant prognostic factors: 13% of patients were classified into stage I, 31% into stage II, 16% into stage III, and 40% into stage IV. Five-year survival rates were 96%, 87%, 74%, and 43% for stages I through IV, respectively.

Conclusions

The newly developed TNM staging system accurately discriminates prognosis for small bowel carcinoid tumors.

Section snippets

Methods

The patient population for this study was obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database. A search of the SEER database identified 15,983 patients with gastrointestinal carcinoid tumors (stomach, small bowel, colon, rectum, appendix) between 1977 and 2004. From these patients, 6,380 had carcinoid tumors of the small bowel. Patients diagnosed with tumors within a Meckel's diverticulum were included. Patients with cause of death in the

Patient demographics

Clinicopathologic characteristics of the patient population are displayed in Table 1. Of the 6,380 patients in the database, 47% were female and 53% were male. The median age at diagnosis was 66 years (range 14–98 years). Small intestinal carcinoid was the only primary malignancy in 68% of patients; 28% presented with 1 additional primary malignancy, and 4.2% had 2 or more additional malignancies. The mean and median sizes of primary tumor were 1.93 cm and 1.5 cm, respectively (range .1–30 cm).

Comments

Carcinoid tumor is a challenging disease to treat, and the lack of a staging system limits the clinician's ability to provide meaningful prognostic information to the patient. In the past, gastrointestinal carcinoid tumors have been divided into 3 groups according to embryologic origin: foregut (esophagus, stomach, pancreas, and duodenum), midgut (tumors from small mesenteric artery (SMA) distribution including ileum, appendix), and hind-gut (tumors from inferior mesenteric artery (IMA)

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