Carcinoids: The prognostic effect of primary site histologic type variations

Abstract

Carcinoids are histologically classified as insular (A), trabecular (B) glandular (C), undifferentiated (D) or mixed. These have prognostic significance, i.e. Group 1 (most favorable, A + C); 2 (favorable, A, B, A + B); 3 (relatively unfavorable, all non A + C or A + B mixed types); and 4 (unfavorable, C, D). Midgut primaries have a better prognosis than either foregut or hindgut/cloacal primaries. Carcinoids from 114 Eastern Cooperative Oncology Group patients were studied to determine if primary site prognostic differences result from histologic prognostic group occurrence rate differences across primary sites. By primary site the following rates were observed: Foregut: 1 (0%), 2 (79.2%), 3 (12.5%), 4 (8.3%); midgut: 1 (26.7%), 2 (58.7%), 3 (6.6%), 4 (8.0%); hindgut/cloaca: 1 (0%), 2 (42.9%), 3 (42.9%), 4 (14.2%); nongut: 1 (0%), 2 (75.0%), 3 (12.5%), 4 (12.5%), p less than 0.01. The results demonstrate that primary site prognostic differences are highly dependent upon histologic prognostic group occurrence rate variations across primary sites. In addition multivariate analysis of survivorship by both histologic type (p less than 0.05) and primary site (p less than 0.05) demonstrated that each variable has independent prognostic significance.

A Three-Decade Analysis of 3,911 Small Intestinal Neuroendocrine Tumors: The Rapid Pace of No Progress

“…For all NETs, including those within the digestive system and small intestine, the best prognosis was for localized grade I (well differentiated) tumors (76.2-84.2% 5-yr survival), and the worst prognosis was for grade III (poorly differentiated) tumors with distant metastases (2.3-14.7% 5-yr survival) ( Table 4). As noted, the small sample numbers preclude robust statistical analyses, but they are consistent with predicted outcome based upon pathological data and suggest that the use of histological grading and local staging is clinically relevant and should be the standard of care to facilitate development of an accurate prognostic index (13)(14)(15).…”

Prognostic factors influencing survival from metastatic (stage IV) gastroenteropancreatic well-differentiated endocrine carcinoma

“…Additionally, in previous multivariate analysis from tertiary referral centers, pathological differentiation and stage at diagnosis have been identified as the strongest prognostic features of GEP NET. Indeed, differentiation of GEP NET classified as poorly compared with well-differentiated (WD) carcinoma (Johnson et al 1986, Greenberg et al 1987, Madeira et al 1998, Travis et al 1998, Rindi et al 1999, Lim et al 2005, Panzuto et al 2005, Asamura et al 2006, Faggiano et al 2007, Lepage et al 2007, Pape et al 2008 and stage (Lo et al 1996, Pelosi et al 1996, Burke et al 1997, Madeira et al 1998, Kirshbom et al 1999, Rindi et al 1999, Shebani et al 1999, Onaitis et al 2000, Quaedvlieg et al 2001, Rigaud et al 2001, Solorzano et al 2001, Hochwald et al 2002, Plöckinger et al 2004, Panzuto et al 2005, Tomassetti et al 2006, Baudin 2007, Pape et al 2008 as long been recognized the strongest prognostic parameters before the primary location. More recently, lymph node metastases (Hellman et al 2002, Cardillo et al 2004, Lim et al 2005, Tomassetti et al 2005, Baudin 2007, García-Yuste et al 2007, Rea et al 2007, Pape et al 2008 and proliferative index have emerged as major determinant of ...…”

Evaluación de la sobrevida a largo plazo del carcinoide del apéndice cecal. Un análisis a partir de 8.903 apendicectomías

“…Esta distribución se podría atribuir a una mayor frecuencia de apendicectomías, cirugía pélvica y laparoscópica en ellas 6,14 . Sin embargo, esto no sería suficiente para explicar este predominio, ya que en series de pacientes jóvenes, menores de 20 años 12,15,16 , en quienes este tipo de cirugía es menos frecuente, también se ha visto un mayor número de mujeres con carcinoides del apéndice. A pesar del bajo número de carcinoides apendiculares diagnosticados después de una apendicectomía, es muy importante recalcar la necesidad del estudio anatomopatológico de todos los apéndices cecales extirpados.…”