Influence of carcinoid syndrome on the clinical characteristics and outcomes of patients with gastroenteropancreatic neuroendocrine tumors undergoing operative resection
| Autor: | Timothy M. Pawlik, Eliza W. Beal, Clifford S. Cho, Carl Schmidt, Mary Dillhoff, Megan Beems, Daniel E. Abbott, Flavio G. Rocha, Ryan C. Fields, Alexandra G. Lopez-Aguiar, Alexander V. Fisher, Eleftherios Makris, Angelena Crown, Bradley A. Krasnick, Kamran Idrees, Jordan M. Cloyd, George A. Poultsides, Paula Marincola-Smith, Charles W. Kimbrough, Shishir K. Maithel |
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| Rok vydání: | 2019 |
| Předmět: |
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medicine.medical_specialty Tumor burden 030230 surgery Neuroendocrine tumors Article Disease-Free Survival Resection 03 medical and health sciences 0302 clinical medicine Stomach Neoplasms Intestinal Neoplasms medicine Humans In patient Neoplasm Metastasis Digestive System Surgical Procedures Aged Malignant Carcinoid Syndrome Retrospective Studies business.industry Incidence Incidence (epidemiology) Retrospective cohort study Middle Aged Prognosis Debulking medicine.disease United States Surgery Pancreatic Neoplasms Survival Rate Neuroendocrine Tumors Lymphatic Metastasis 030220 oncology & carcinogenesis Female business Carcinoid syndrome Follow-Up Studies |
| Zdroj: | Surgery |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2018.09.008 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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