Gastrointestinal Carcinoids: Characterization by Site of Origin and Hormone Production

Onaitis, Mark W.; Kirshbom, Paul M.; Hayward, Thomas Z.; Quayle, Frank J.; Feldman, Jerome M.; Seigler, Hilliard F.; Tyler, Douglas S.

doi:10.1097/00000658-200010000-00010

Cited by 100 publications

(99 citation statements)

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“…Previously, Clancy et al (2006) first found age and alkaline phosphatase level, probably as a surrogate marker of liver tumor burden, to be important prognostic parameters in patients with metastatic GEP tumors; gender, primary location, CGA level, and presence of liver metastases were not found to be predictive. Our study includes a comprehensive list of detailed prognostic parameters considered to be important in previous studies including pancreatic primary (Onaitis et al 2000, Panzuto et al 2005, extra-hepatic metastases (Yu et al 1999, Panzuto et al 2005, extent of liver metastases (Weber et al 1995, Lo et al 1996, Yu et al 1999, Chamberlain et al 2000, Solorzano et al 2001, level of serum biological markers (Janson et al 1997, Onaitis et al 2000, Turner et al 2006, presence of a functioning tumor (Pellikka et al 1993), and also the spontaneous tumor burden slope (Madeira et al 1998, Arnold et al 2005.…”

Section: Discussionmentioning

confidence: 99%

“…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 ...…”

Section: Introductionmentioning

confidence: 99%

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

Durante¹,

Boukheris²,

Dromain³

et al. 2009

Endocrine-Related Cancer

104

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Survival of metastatic gastroenteropancreatic well-differentiated endocrine carcinoma (GEP WDEC) is not well characterized. We evaluated the long-term outcome and prognostic factors for survival in 118 patients with distant metastases from GEP WDEC. Inclusion criteria were 1) pathological review by a single pathologist according to the present WHO criteria, 2) absence of previous therapy apart from surgery, 3) complete morphological evaluation within 3 months including somatostatin receptor scintigraphy, and 4) follow-up at Gustave-Roussy Institute until death or study's end. Clinical, biological marker, and pathological parameters were analyzed in univariate and multivariate statistical models. Survival after the first complete imaging work-up of the metastatic disease was determined using Kaplan-Meier method. Overall, survival for 5 years after the diagnosis of metastatic disease was 54%. In multivariate analysis, age (hazard ratio (HR): 1.05, 95% confidence interval (CI): 1.01-1.08, PZ0.01), the number of liver metastases (HR: 3.4, 95% CI: 1.4-8.3, PZ0.01), tumor slope (HR: 1.1, 95% CI: 1.0-1.1, PZ0.001), and initial surgery (HR: 0.3, 95% CI: 0.1-0.8, PZ0.01) were predictive of survival. Five-year survival was 100%, 91% (95% CI, 51-98%), 62% (95% CI, 37-83%), and 9% (95% CI, 6-32%) when patients had 0, 1, 2, 3 or more poor prognostic features respectively. This study enables the stratification of metastatic GEP WDEC patients into distinct risk groups. These risk categories can be used to tailor therapeutic approaches and also to design and interpret clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Durante¹,

Boukheris²,

Dromain³

et al. 2009

Endocrine-Related Cancer

104

View full text Add to dashboard Cite

show abstract

“…In a study by Meijer et al (2000) including a mixed population of healthy people, carcinoid NET patients, non-carcinoid NET patients and non-neuroendocrine cancer patients (688 subjects in total), 25 non-carcinoid NETs were associated with raised u5HIAA level and for 7 of these 'high-levels' of u5HIAA (higher than 2.4 times the ULN) were observed. Its prognostic influence, however, has been previously reported (Janson et al, 1997;Onaitis et al, 2000). An increasingly evaluated prognostic marker for NET, the tumour marker CgA, was not included in our analysis as it was not available for many patients (Baudin et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

The prognostic role of WHO classification, urinary 5-hydroxyindoleacetic acid and liver function tests in metastatic neuroendocrine carcinomas of the gastroenteropancreatic tract

et al. 2007

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The World Health Organisation (WHO) classification (2000) is widely used to classify neuroendocrine carcinomas (NECs), yet its prognostic value needs to be confirmed. In this study, patients with metastatic NECs (n ¼ 119) were classified according to WHO guidelines into well differentiated and poorly differentiated (WDNECs and PDNECs). Histological differentiation based on WHO criteria had the highest impact on overall survival (OS) (PDNECs : WDNECs hazard ratio (HR) ¼ 4.02, P ¼ 0.02); however, PDNECs represented only a small percentage of patients (8%). In a WDNEC-restricted analysis, abnormal liver function tests (LFTs) and elevated urinary 5-hydroxyindoleacetic acid (u5HIAA) were independent prognostic factors for survival (HR ¼ 2.65, P ¼ 0.006 and HR ¼ 2.51, P ¼ 0.003, respectively) and were used to create a WDNEC-specific prognostic model (low risk ¼ both normal, intermediate risk ¼ one of them abnormal, high risk ¼ both abnormal). Low-risk WDNECs had the most favourable prognosis (median OS, mOS 8.1 years), which was significantly better compared to both intermediate-risk and high-risk WDNECs (mOS 3.2 and 1.4 years, with P ¼ 0.01 and Po0.001, respectively). High-risk WDNECs displayed the shortest OS (1.3 years), which was similar to that of PDNECs (P ¼ 0.572). This analysis supports the prognostic value of WHO classification for metastatic NECs arising from the gastroenteropancreatic tract; however, risk stratification using readily available u5HIAA and LFTs may be necessary for the heterogeneous group of WDNECs.

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“…26 The small intestine and the appendix were the most common sites for gastrointestinal tract carcinoids in most studies based on Western populations. 2,[4][5][6][16][17][18] Mediastinal/thymic carcinoids were more common in men and accounted for 342 of 8970 (3.8%) gut-pancreatic endocrinomas that were listed of the Japanese Niigata Registry. 27 Therefore, thymic carcinoids are relatively common in Japan and have a male predominance, as reported in our patients.…”

Section: Distribution Of Carcinoidsmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][11][12][13][14][15] It has been suggested that ethnic background and genetic predisposition may play important roles in the incidence and locations of carcinoid tumors. 2,[4][5][6][16][17][18][19] A 5-decade analysis of 13,715 carcinoid tumors in the United States, currently the largest epidemiologic series, demonstrated that the gastrointestinal tract (67.5%) and the bronchopulmonary system (25.3%) are the most commonly affected sites. Within the gastrointestinal tract, carcinoid tumors occurred mostly in the small intestine (41.8%), rectum (27.4%), and stomach (8.7%).…”

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confidence: 99%

A 35‐year retrospective study of carcinoid tumors in Taiwan

Hsu

Li³

et al. 2007

Cancer

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Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) represent useful models for studying multiple myeloma precursor disease, and for developing early intervention strategies. Administering a 4g dose of curcumin, we performed a randomised, double‐blind placebo‐controlled cross‐over study, followed by an open‐label extension study using an 8g dose to assess the effect of curcumin on FLC response and bone turnover in patients with MGUS and SMM. 36 patients (19 MGUS and 17 SMM) were randomised into two groups: one received 4g curcumin and the other 4g placebo, crossing over at 3 months. At completion of the 4g arm, all patients were given the option of entering an open‐label, 8g dose extension study. Blood and urine samples were collected at specified intervals for specific marker analyses. Group values are expressed as mean ± 1 SD. Data from different time intervals within groups were compared using Student's paired t‐test. 25 patients completed the 4g cross‐over study and 18 the 8g extension study. Curcumin therapy decreased the free light‐chain ratio (rFLC), reduced the difference between clonal and nonclonal light‐chain (dFLC) and involved free light‐chain (iFLC). uDPYD, a marker of bone resorption, decreased in the curcumin arm and increased on the placebo arm. Serum creatinine levels tended to diminish on curcumin therapy. These findings suggest that curcumin might have the potential to slow the disease process in patients with MGUS and SMM. Am. J. Hematol. 87:455–460, 2012. © 2012 Wiley Periodicals, Inc.

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Gastrointestinal Carcinoids: Characterization by Site of Origin and Hormone Production

Cited by 100 publications

References 20 publications

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

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

The prognostic role of WHO classification, urinary 5-hydroxyindoleacetic acid and liver function tests in metastatic neuroendocrine carcinomas of the gastroenteropancreatic tract

A 35‐year retrospective study of carcinoid tumors in Taiwan

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