Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract

Rorstad, O.P.

doi:10.1002/jso.20179

Cited by 196 publications

(132 citation statements)

References 68 publications

(144 reference statements)

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“…Chromogranin A (CgA) is a secretory product of most NETs and is used as a marker for tumor burden [3]. CS manifests through four key symptoms: flushing (occurs in 94% of patients with CS), diarrhea (78%), cardiac disease caused by valvular heart lesions (53%), and abdominal pain or cramping (51%) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Clinical Benefits of Above-Standard Dose of Octreotide LAR in Patients With Neuroendocrine Tumors for Control of Carcinoid Syndrome Symptoms: A Multicenter Retrospective Chart Review Study

et al. 2014

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Background. Octreotide LAR is used in patients for control of carcinoid syndrome (CS) and other symptoms of hormone hypersecretion. The aim of this study was to examine reasons for octreotide LAR dose escalation and observe CS symptom improvement in patients with neuroendocrine tumors (NETs) who underwent octreotide LAR dose escalation at three cancer referral centers. Methods. Medical records for patients with diagnosis of carcinoid or pancreatic NET who had received one dose or more of octreotide LAR above 30 mg every 4 weeks from 2000 to 2012 were reviewed. Reasons for dose escalation and symptomatic outcomes were abstracted for each patient 3 months prior to and up to 12 months following the dose escalation. Results. Of the evaluated 239 NET patients, 53% were male, mean age at first dose escalation was 60 years (standard deviation [SD]: 11 years), and mean time from octreotide LAR

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Section: Introductionmentioning

confidence: 99%

Clinical Benefits of Above-Standard Dose of Octreotide LAR in Patients With Neuroendocrine Tumors for Control of Carcinoid Syndrome Symptoms: A Multicenter Retrospective Chart Review Study

et al. 2014

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“…4 The majority of studies to date have investigated carcinoid tumours as a collective group. [5][6][7][8][9][10] Pulmonary, gastric, and midgut tumours (that include appendiceal tumours in many studies) are heterogeneous, 11 making interpretation of the available results specifically for midgut tumours very difficult. One of the few papers studying the effect of biochemical markers on survival for midgut carcinoid tumours concluded that only chromogranin A and increasing age were independent markers of outcome.…”

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confidence: 99%

Circulating markers of prognosis and response to treatment in patients with midgut carcinoid tumours

Turner

Johnston

McCance

et al. 2006

Gut

108

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Background and aims: Midgut carcinoid tumours are uncommon tumours with an unpredictable clinical behaviour and few useful prognostic markers. Somatostatin analogues are widely used in treatment but a survival advantage has not been proven. We analysed features associated with poor prognosis and assessed the clinical implications of the biochemical response to therapy. Methods: Clinical and biochemical data were collected for patients with midgut carcinoid tumours attending a tertiary referral neuroendocrine clinic from 1978 to 2000. Using death as the end point, univariate and multivariate survival analyses were performed to identify prognostic indicators. The significance of altering biomarkers with therapy was also studied by including repeated measurements of the most prognostic biochemical parameter in a time dependent covariate survival analysis. Results: We identified 139 patients with sufficient data for our analyses. Factors associated with a poor outcome on univariate analysis included: plasma neurokinin A (NKA), urinary 5-hydroxyindolacetic acid output, age, and >5 liver metastases. Plasma NKA was the strongest and only independent predictor of outcome on multivariate analysis. Patients in whom NKA continued to rise despite somatostatin analogues had a significantly worse survival than those in whom NKA stabilised or fell (one year survival rate 40% v 87%). Time dependent covariate analysis concluded that survival was better predicted by the most recent plasma NKA value rather than by the initial value. Conclusions: Plasma NKA is an accurate marker of prognosis for midgut carcinoid tumours. This is the first paper to support a survival advantage in patients in whom plasma NKA is altered by somatostatin analogues.

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“…As mentioned in the ''Results,'' none of those 4 patients had a documented primary neuroendocrine tumor of another organ in the electronic medical record or pathology database either before or after their surgery. Considering that even JINETs smaller than 1 cm can metastasize, 25 it is possible that the primary tumors were missed intraoperatively by the surgeon. We considered these tumors to most likely represent mesenteric involvement by a primary JINET, but technically the origin was indeterminate because the primary tumor was not identified.…”

Section: Commentmentioning

confidence: 99%

Jejunoileal Neuroendocrine Tumors Complicated by Intestinal Ischemic Necrosis Are Associated With Worse Overall Survival

Landau

Wisniewski

Davison

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Jejunoileal neuroendocrine tumors (JINETs) are slow-growing, malignant tumors that are often associated with protracted survival, despite their frequent presentation at an advanced stage. A subset of JINETs is complicated by intestinal ischemic necrosis (IIN), which leads to their initial clinical presentation.Objective.-To assess the effect of IIN on overall survival in patients with JINETs.Design.-Ten JINETs with IIN during a 14-year period and a control group of 52 JINETs without IIN were identified retrospectively. The hematoxylin-eosin slides and gross descriptions were reviewed, and pathologic features were assessed. Overall survival was compared between the 2 groups using the Kaplan Meier method and Cox proportional hazards model.Results.-At 1 year postresection, only 40% (4 of 10) of the patients with IIN were alive, whereas 94% (49 of 52) of those without IIN were alive (P , .001). Patients with IIN were significantly older than those without IIN (median, 83 years versus 65.5 years, P ¼ .001). By univariate Cox proportional hazards regression, IIN was associated with a 4.30-fold increased risk of death (95% confidence interval 1.75-10.56; P ¼ .001). When controlling for age, advanced stage (stage III or IV), tumor grade, and synchronous carcinoma in a multivariate analysis, IIN showed a trend toward prognostic significance (2.31-fold increased risk of death; 95% confidence interval, 0.85-6.27; P ¼ .10).Conclusions.-The pathologic identification of tumorassociated IIN portends a worse overall survival among patients with JINETs.

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Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract

Cited by 196 publications

References 68 publications

Clinical Benefits of Above-Standard Dose of Octreotide LAR in Patients With Neuroendocrine Tumors for Control of Carcinoid Syndrome Symptoms: A Multicenter Retrospective Chart Review Study

Clinical Benefits of Above-Standard Dose of Octreotide LAR in Patients With Neuroendocrine Tumors for Control of Carcinoid Syndrome Symptoms: A Multicenter Retrospective Chart Review Study

Circulating markers of prognosis and response to treatment in patients with midgut carcinoid tumours

Jejunoileal Neuroendocrine Tumors Complicated by Intestinal Ischemic Necrosis Are Associated With Worse Overall Survival

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