Influence of carcinoid syndrome on the clinical characteristics and outcomes of patients with gastroenteropancreatic neuroendocrine tumors undergoing operative resection.

Autor: Kimbrough CW; Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH., Beal EW; Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH., Dillhoff ME; Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH., Schmidt CR; Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH., Pawlik TM; Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH., Lopez-Aguiar AG; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Poultsides G; Department of Surgery, Stanford University Medical Center, Stanford, CA., Makris E; Department of Surgery, Stanford University Medical Center, Stanford, CA., Rocha FG; Department of Surgery, Virginia Mason Medical Center, Seattle, WA., Crown A; Department of Surgery, Virginia Mason Medical Center, Seattle, WA., Abbott DE; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Fisher AV; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Fields RC; Department of Surgery, Washington University School of Medicine, St Louis, MO., Krasnick BA; Department of Surgery, Washington University School of Medicine, St Louis, MO., Idrees K; Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN., Marincola-Smith P; Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN., Cho CS; Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI., Beems M; Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI., Maithel SK; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA., Cloyd JM; Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH. Electronic address: jordan.cloyd@osumc.edu.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2019 Mar; Vol. 165 (3), pp. 657-663. Date of Electronic Publication: 2018 Oct 28.
DOI: 10.1016/j.surg.2018.09.008
Abstrakt: Background: The incidence, clinical characteristics, and long-term outcomes of patients with gastroenteropancreatic neuroendrocrine tumors and carcinoid syndrome undergoing operative resection have not been well characterized.
Methods: Patients undergoing resection of primary or metastatic gastroenteropancreatic neuroendrocrine tumors between 2000 and 2016 were identified from an 8-institution collaborative database. Clinicopathologic and postoperative characteristics as well as overall survival and disease-free survival were compared among patients with and without carcinoid syndrome.
Results: Among 2,182 patients who underwent resection, 139 (6.4%) had preoperative carcinoid syndrome. Patients with carcinoid syndrome were more likely to have midgut primary tumors (44.6% vs 21.4%, P < .001), lymph node metastasis (63.4% vs 44.3%, P < .001), and metastatic disease (62.8% vs 26.7%, P < .001). There was no difference in tumor differentiation, grade, or Ki67 status. Perioperative carcinoid crisis was rare (1.6% vs 0%, P < .01), and the presence of preoperative carcinoid syndrome was not associated with postoperative morbidity (38.8% vs 45.5%, P = .129). Substantial symptom improvement was reported in 59.5% of patients who underwent curative-intent resection, but occurred in only 22.7% who underwent debulking. Despite an association on univariate analysis (P = .04), carcinoid syndrome was not independently associated with disease-free survival after controlling for confounding factors (hazard ratio 0.97, 95% confidence interval 0.64-1.45). Preoperative carcinoid syndrome was not associated with overall survival on univariate or multivariate analysis.
Conclusion: Among patients undergoing operative resection of gastroenteropancreatic neuroendrocrine tumors, the prevalence of preoperative carcinoid syndrome was low. Although operative intervention with resection or especially debulking in patients with carcinoid syndrome was disappointing and often failed to improve symptoms, after controlling for markers of tumor burden, carcinoid syndrome was not independently associated with worse disease-free survival or overall survival.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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