Long-term follow-up of a large series of patients with type 1 gastric carcinoid tumors: data from a multicenter study

Abstract

Objective: To study the clinical presentation, diagnostic approach, response to treatment, and the presence of other pathologies in patients with gastric carcinoid type 1 (GC 1) tumors. Design and methods: Retrospective analysis of 111 patients from four institutions and a mean follow-up of 76 months. Results: The main indications for gastroscopy were upper gastrointestinal tract symptoms. The mean number of lesions, maximum tumoral diameter, and percentage of cells expressing Ki-67 labeling index were 3.6G3.8, 8G12.1 mm and 1.9G2.4% respectively. Serum gastrin and chromogranin A (CgA) levels were elevated in 100/101 and 85/90 patients respectively. Conventional imaging studies demonstrated pathology in 9/111 patients. Scintigraphy with radiolabeled octreotide was positive in 6/60 without revealing any additional lesions. From the 59 patients who had been followed-up without any intervention, five developed tumor progression. Thirty-two patients were treated with long-acting somatostatin analogs (SSAs), leading to a significant reduction of gastrin and CgA levels, number of visible tumors, and CgA immune-reactive tumor cells in 28, 19, 27, and 23 treated patients respectively. Antrectomy and/or gastrectomy were initially performed in 20 patients and a complete response was achieved in 13 patients. The most common comorbidities were vitamin B12 deficiency, thyroiditis, and parathyroid adenomas. Conclusions: Most GCs1 are grade 1 (82.7%) tumors presenting with stage I (73.9%) disease with no mortality after prolonged follow-up. Ocreoscan did not provide further information compared with conventional imaging techniques. Treatment with SSAs proved to be effective for the duration of administration.

Gastric neuroendocrine tumors: management and challenges

“…28,29 Limited studies, including a few small prospective studies, have demonstrated regression or complete disappearance of tumors and marked decrease in serum gastrin, lasting up to several years. [30][31][32][33][34][35][36][37][38][39] SSAs (e.g. octreotide and lanreotide) can be considered in cases in which endoscopic resection is not feasible due to extensive multifocal disease, or submucosal/lymph node involvement, as well as recurrent disease after repeated endoscopic resection.…”

Nowotwory neuroendokrynne żołądka i dwunastnicy z uwzględnieniem gastrinoma (zasady postępowania rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

“…In well-differentiated neoplasms less than 1 cm, only observation and control endoscopy every 12 months is possible [52], or endoscopic excision [10]. In well-differentiated neoplasms larger than 1 cm, in EUS test not invading the muscularis propria, endoscopic mucosal dissection (ESD) is the preferred method [53].…”

A single center series highlights on incidence and management of gastric neuroendocrine tumours with literature review

“…In this series, index cases 1-5 and 7-9 (Table 1) were of Type I which usually accounts for 70% -80% of gastric NET cases. They are small multifocal lesions (median diameter of 5 mm) associated with autoimmune chronic atrophic gastritis, due to gastric achlorhydria-hypergastrinemiaenterochromaffin cell hyperplasia/ tumour mechanism [5,6,8,18] They occur mostly in women and are usually nonfunctioning tumors, typically found during UGI endoscopy performed for dyspepsia or for macrocytic or iron deficiency anemia They are usually benign and well differentiated (NET G1), however, rare cases of metastatic spread and bad prognosis have been described [13]. Index case 4 ( Figures 1a, 1b, 1c) small polyp on OGD with haematoxylin/ eosin and synaptophysin markers on histology respectively while index case 8 ( Figure 2) shows an umbilicated lesion.…”

“…Being usually well differentiated and with low Ki67 (NET G1), generally have an excellent prognosis. Five year survival rates are >95% but they have an indolent clinical course with a median recurrence-free survival of 24 months [5,18,22,23]. Guidelines for post treatment surveillance from the National Comprehensive Cancer Network NCCN, the North American Neuroendocrine Tumour Society (NANETS) and the European Neuroendocrine Tumour Society (ENETS) of Type I and II gastric carcinoids ≤2 cm include history and physical examination with 6 to 12 monthly upper endoscopy for three years and annually thereafter.…”