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Erschienen in: Digestive Diseases and Sciences 4/2015

01.04.2015 | Original Article

Management and Disease Outcome of Type I Gastric Neuroendocrine Tumors: The Mount Sinai Experience

verfasst von: William C. Chen, Richard R. P. Warner, Stephen C. Ward, Noam Harpaz, Celia M. Divino, Steven H. Itzkowitz, Michelle K. Kim

Erschienen in: Digestive Diseases and Sciences | Ausgabe 4/2015

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Abstract

Background and Aim

The incidence of gastric neuroendocrine tumors (NETs) has increased tenfold since the 1970s. Our aim was to describe the clinicopathologic profile, management, and outcomes of type I gastric NETs at The Mount Sinai Hospital.

Methods

From existing databases of the Mount Sinai Division of Gastrointestinal Pathology and the Carcinoid Cancer Foundation, we identified 56 patients with type I gastric NETs seen at The Mount Sinai Hospital from 1993 to 2012. We generated a comprehensive dataset encompassing demographic, clinical, endoscopic, and pathologic factors. Survival information was determined from medical records and the Social Security Death Index. Tumor–node–metastasis staging was conducted, and tumors were graded based on mitotic counts and Ki67 index.

Results

Median NET size was 3.0 mm; 55.8 % displayed multifocal disease. Stages I, II, III, and IV disease were observed in 83.8, 10.8, 5.4, and 0 %, respectively. Tumors were either low (69.7 %) or intermediate (30.3 %) grade. Furthermore, 3.6 % of patients developed gastric dysplasia, and 5.5 % had gastric adenocarcinoma. Patients underwent endoscopy every 15 months, while 28.6 % underwent polypectomy, 32.7 % somatostatin therapy, and 46.4 % surgical resection. 5- and 10-year disease-specific survival was 100 %.

Conclusions

Most patients received annual endoscopic surveillance, with a minority undergoing surgical resection, though outcomes remained excellent independent of therapeutic approach. We identified a very low but real rate of loco-regional spread, despite the generally indolent behavior of type I gastric NETs. Several patients demonstrated concurrent dysplasia or adenocarcinoma, underscoring the efficacy of regular endoscopic management not only for gastric NETs, but also for dysplasia and adenocarcinoma.
Literatur
1.
Zurück zum Zitat Merola E, Sbrozzi-Vanni A, Panzuto F, et al. Type I gastric carcinoids: a prospective study on endoscopic management and recurrence rate. Neuroendocrinology. 2012;95:207–213. CrossRefPubMed Merola E, Sbrozzi-Vanni A, Panzuto F, et al. Type I gastric carcinoids: a prospective study on endoscopic management and recurrence rate. Neuroendocrinology. 2012;95:207–213. CrossRefPubMed
2.
Zurück zum Zitat Ozao-Choy J, Buch K, Strauchen JA, et al. Laparoscopic antrectomy for the treatment of type I gastric carcinoid tumors. J Surg Res. 2010;162:22–25. CrossRefPubMed Ozao-Choy J, Buch K, Strauchen JA, et al. Laparoscopic antrectomy for the treatment of type I gastric carcinoid tumors. J Surg Res. 2010;162:22–25. CrossRefPubMed
3.
Zurück zum Zitat Rindi G, Azzoni C, La Rosa S, et al. ECL cell tumor and poorly differentiated endocrine carcinoma of the stomach: prognostic evaluation by pathological analysis. Gastroenterology. 1999;116:532–542. CrossRefPubMed Rindi G, Azzoni C, La Rosa S, et al. ECL cell tumor and poorly differentiated endocrine carcinoma of the stomach: prognostic evaluation by pathological analysis. Gastroenterology. 1999;116:532–542. CrossRefPubMed
4.
Zurück zum Zitat Dakin GF, Warner RR, Pomp A, et al. Presentation, treatment, and outcome of type 1 gastric carcinoid tumors. J Surg Oncol. 2006;93:368–372. CrossRefPubMed Dakin GF, Warner RR, Pomp A, et al. Presentation, treatment, and outcome of type 1 gastric carcinoid tumors. J Surg Oncol. 2006;93:368–372. CrossRefPubMed
5.
Zurück zum Zitat Gladdy RA, Strong VE, Coit D, et al. Defining surgical indications for type I gastric carcinoid tumor. Ann Surg Oncol. 2009;16:3154–3160. CrossRefPubMed Gladdy RA, Strong VE, Coit D, et al. Defining surgical indications for type I gastric carcinoid tumor. Ann Surg Oncol. 2009;16:3154–3160. CrossRefPubMed
6.
Zurück zum Zitat Saund MS, Al Natour RH, Sharma AM, et al. Tumor size and depth predict rate of lymph node metastasis and utilization of lymph node sampling in surgically managed gastric carcinoids. Ann Surg Oncol. 2011;18:2826–2832. CrossRefPubMed Saund MS, Al Natour RH, Sharma AM, et al. Tumor size and depth predict rate of lymph node metastasis and utilization of lymph node sampling in surgically managed gastric carcinoids. Ann Surg Oncol. 2011;18:2826–2832. CrossRefPubMed
7.
Zurück zum Zitat Solcia E, Rindi G, Silini E, et al. Enterochromaffin-like (ECL) cells and their growths: relationships to gastrin, reduced acid secretion and gastritis. Baillieres Clin Gastroenterol. 1993;7:149–165. CrossRefPubMed Solcia E, Rindi G, Silini E, et al. Enterochromaffin-like (ECL) cells and their growths: relationships to gastrin, reduced acid secretion and gastritis. Baillieres Clin Gastroenterol. 1993;7:149–165. CrossRefPubMed
8.
Zurück zum Zitat Rindi G, Luinetti O, Cornaggia M, et al. Three subtypes of gastric argyrophil carcinoid and the gastric neuroendocrine carcinoma: a clinicopathologic study. Gastroenterology. 1993;104:994–1006. PubMed Rindi G, Luinetti O, Cornaggia M, et al. Three subtypes of gastric argyrophil carcinoid and the gastric neuroendocrine carcinoma: a clinicopathologic study. Gastroenterology. 1993;104:994–1006. PubMed
9.
Zurück zum Zitat Modlin IM, Lye KD, Kidd M. A 50-year analysis of 562 gastric carcinoids: small tumor or larger problem? Am J Gastroenterol. 2004;99:23–32. CrossRefPubMed Modlin IM, Lye KD, Kidd M. A 50-year analysis of 562 gastric carcinoids: small tumor or larger problem? Am J Gastroenterol. 2004;99:23–32. CrossRefPubMed
10.
Zurück zum Zitat Lawrence B, Gustafsson BI, Chan A, et al. The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am. 2011;40:1–18. CrossRefPubMed Lawrence B, Gustafsson BI, Chan A, et al. The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am. 2011;40:1–18. CrossRefPubMed
11.
Zurück zum Zitat Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97:934–959. CrossRefPubMed Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97:934–959. CrossRefPubMed
12.
Zurück zum Zitat Modlin IM, Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer. 1997;79:813–829. CrossRefPubMed Modlin IM, Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer. 1997;79:813–829. CrossRefPubMed
13.
Zurück zum Zitat Modlin IM, Sandor A, Tang LH, et al. A 40-year analysis of 265 gastric carcinoids. Am J Gastroenterol. 1997;92:633–638. PubMed Modlin IM, Sandor A, Tang LH, et al. A 40-year analysis of 265 gastric carcinoids. Am J Gastroenterol. 1997;92:633–638. PubMed
14.
Zurück zum Zitat Hodgson N, Koniaris LG, Livingstone AS, et al. Gastric carcinoids: a temporal increase with proton pump introduction. Surg Endosc. 2005;19:1610–1612. CrossRefPubMed Hodgson N, Koniaris LG, Livingstone AS, et al. Gastric carcinoids: a temporal increase with proton pump introduction. Surg Endosc. 2005;19:1610–1612. CrossRefPubMed
15.
Zurück zum Zitat Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26:3063–3072. CrossRefPubMed Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26:3063–3072. CrossRefPubMed
18.
Zurück zum Zitat Borch K, Ahren B, Ahlman H, et al. Gastric carcinoids: biologic behavior and prognosis after differentiated treatment in relation to type. Ann Surg. 2005;242:64–73. CrossRefPubMedCentralPubMed Borch K, Ahren B, Ahlman H, et al. Gastric carcinoids: biologic behavior and prognosis after differentiated treatment in relation to type. Ann Surg. 2005;242:64–73. CrossRefPubMedCentralPubMed
19.
Zurück zum Zitat Hirschowitz BI, Griffith J, Pellegrin D, et al. Rapid regression of enterochromaffin like cell gastric carcinoids in pernicious anemia after antrectomy. Gastroenterology. 1992;102:1409–1418. PubMed Hirschowitz BI, Griffith J, Pellegrin D, et al. Rapid regression of enterochromaffin like cell gastric carcinoids in pernicious anemia after antrectomy. Gastroenterology. 1992;102:1409–1418. PubMed
20.
Zurück zum Zitat Higham AD, Dimaline R, Varro A, et al. Octreotide suppression test predicts beneficial outcome from antrectomy in a patient with gastric carcinoid tumor. Gastroenterology. 1998;114:817–822. CrossRefPubMed Higham AD, Dimaline R, Varro A, et al. Octreotide suppression test predicts beneficial outcome from antrectomy in a patient with gastric carcinoid tumor. Gastroenterology. 1998;114:817–822. CrossRefPubMed
21.
Zurück zum Zitat Ferraro G, Annibale B, Marignani M, et al. Effectiveness of octreotide in controlling fasting hypergastrinemia and related enterochromaffin-like cell growth. J Clin Endocrinol Metab. 1996;81:677–683. PubMed Ferraro G, Annibale B, Marignani M, et al. Effectiveness of octreotide in controlling fasting hypergastrinemia and related enterochromaffin-like cell growth. J Clin Endocrinol Metab. 1996;81:677–683. PubMed
22.
Zurück zum Zitat Granberg D, Wilander E, Stridsberg M, et al. Clinical symptoms, hormone profiles, treatment, and prognosis in patients with gastric carcinoids. Gut. 1998;43:223–228. CrossRefPubMedCentralPubMed Granberg D, Wilander E, Stridsberg M, et al. Clinical symptoms, hormone profiles, treatment, and prognosis in patients with gastric carcinoids. Gut. 1998;43:223–228. CrossRefPubMedCentralPubMed
23.
Zurück zum Zitat Soga J. Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases. Cancer. 2005;103:1587–1595. CrossRefPubMed Soga J. Early-stage carcinoids of the gastrointestinal tract: an analysis of 1914 reported cases. Cancer. 2005;103:1587–1595. CrossRefPubMed
24.
Zurück zum Zitat Jordan PH Jr, Barroso A, Sweeney J. Gastric carcinoids in patients with hypergastrinemia. J Am Coll Surg. 2004;199:552–555. CrossRefPubMed Jordan PH Jr, Barroso A, Sweeney J. Gastric carcinoids in patients with hypergastrinemia. J Am Coll Surg. 2004;199:552–555. CrossRefPubMed
25.
Zurück zum Zitat Kulke MH, Anthony LB, Bushnell DL, et al. NANETS treatment guidelines: well-differentiated neuroendocrine tumors of the stomach and pancreas. Pancreas. 2010;39:735–752. CrossRefPubMedCentralPubMed Kulke MH, Anthony LB, Bushnell DL, et al. NANETS treatment guidelines: well-differentiated neuroendocrine tumors of the stomach and pancreas. Pancreas. 2010;39:735–752. CrossRefPubMedCentralPubMed
26.
Zurück zum Zitat Klimstra DS, Modlin IR, Coppola D, et al. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas. 2010;39:707–712. CrossRefPubMed Klimstra DS, Modlin IR, Coppola D, et al. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas. 2010;39:707–712. CrossRefPubMed
27.
Zurück zum Zitat Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
28.
Zurück zum Zitat Carmel R. Reassessment of the relative prevalences of antibodies to gastric parietal cell and to intrinsic factor in patients with pernicious anaemia: influence of patient age and race. Clin Exp Immunol. 1992;89:74–77. CrossRefPubMedCentralPubMed Carmel R. Reassessment of the relative prevalences of antibodies to gastric parietal cell and to intrinsic factor in patients with pernicious anaemia: influence of patient age and race. Clin Exp Immunol. 1992;89:74–77. CrossRefPubMedCentralPubMed
29.
Zurück zum Zitat Ottesen M, Feldt-Rasmussen UF, Andersen J, et al. Pernicious anemia. A study of initial forms of the disease and diagnostic significance of determination of the intrinsic factor antibody and parietal cell antibody. Ugeskr Laeger. 1992;154:3758–3762. PubMed Ottesen M, Feldt-Rasmussen UF, Andersen J, et al. Pernicious anemia. A study of initial forms of the disease and diagnostic significance of determination of the intrinsic factor antibody and parietal cell antibody. Ugeskr Laeger. 1992;154:3758–3762. PubMed
30.
Zurück zum Zitat Schindl M, Kaserer K, Niederle B. Treatment of gastric neuroendocrine tumors: the necessity of a type-adapted treatment. Arch Surg. 2001;136:49–54. CrossRefPubMed Schindl M, Kaserer K, Niederle B. Treatment of gastric neuroendocrine tumors: the necessity of a type-adapted treatment. Arch Surg. 2001;136:49–54. CrossRefPubMed
31.
Zurück zum Zitat Wiedenmann B, Jensen RT, Mignon M, et al. Preoperative diagnosis and surgical management of neuroendocrine gastroenteropancreatic tumors: general recommendations by a consensus workshop. World J Surg. 1998;22:309–318. CrossRefPubMed Wiedenmann B, Jensen RT, Mignon M, et al. Preoperative diagnosis and surgical management of neuroendocrine gastroenteropancreatic tumors: general recommendations by a consensus workshop. World J Surg. 1998;22:309–318. CrossRefPubMed
32.
Zurück zum Zitat Zissis D, Zizi-Serbetzoglou A, Grammatoglou X, et al. Combined carcinoid and mixed (composite) glandular-endocrine cell carcinoma of the stomach in atrophic gastritis. J BUON. 2009;14:127–130. PubMed Zissis D, Zizi-Serbetzoglou A, Grammatoglou X, et al. Combined carcinoid and mixed (composite) glandular-endocrine cell carcinoma of the stomach in atrophic gastritis. J BUON. 2009;14:127–130. PubMed
33.
Zurück zum Zitat Ronellenfitsch U, Strobel P, Schwarzbach MH, et al. A composite adenoendocrine carcinoma of the stomach arising from a neuroendocrine tumor. J Gastrointest Surg. 2007;11:1573–1575. CrossRefPubMed Ronellenfitsch U, Strobel P, Schwarzbach MH, et al. A composite adenoendocrine carcinoma of the stomach arising from a neuroendocrine tumor. J Gastrointest Surg. 2007;11:1573–1575. CrossRefPubMed
34.
Zurück zum Zitat Jain D, Eslami-Varzaneh F, Takano AM, et al. Composite glandular and endocrine tumors of the stomach with pancreatic acinar differentiation. Am J Surg Pathol. 2005;29:1524–1529. CrossRefPubMed Jain D, Eslami-Varzaneh F, Takano AM, et al. Composite glandular and endocrine tumors of the stomach with pancreatic acinar differentiation. Am J Surg Pathol. 2005;29:1524–1529. CrossRefPubMed
35.
Zurück zum Zitat Yang GC, Rotterdam H. Mixed (composite) glandular-endocrine cell carcinoma of the stomach. Report of a case and review of literature. Am J Surg Pathol. 1991;15:592–598. CrossRefPubMed Yang GC, Rotterdam H. Mixed (composite) glandular-endocrine cell carcinoma of the stomach. Report of a case and review of literature. Am J Surg Pathol. 1991;15:592–598. CrossRefPubMed
36.
Zurück zum Zitat Lee EJ, Park SM, Maeng L, et al. Composite glandular-endocrine cell carcinomas of the stomach: clinicopathologic and methylation study. APMIS. 2005;113:569–576. CrossRefPubMed Lee EJ, Park SM, Maeng L, et al. Composite glandular-endocrine cell carcinomas of the stomach: clinicopathologic and methylation study. APMIS. 2005;113:569–576. CrossRefPubMed
37.
Zurück zum Zitat de Vries AC, van Grieken NC, Looman CW, et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology. 2008;134:945–952. CrossRefPubMed de Vries AC, van Grieken NC, Looman CW, et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology. 2008;134:945–952. CrossRefPubMed
38.
Zurück zum Zitat Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992;52:6735–6740. PubMed Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992;52:6735–6740. PubMed
39.
Zurück zum Zitat Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med. 2001;345:784–789. CrossRefPubMed Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med. 2001;345:784–789. CrossRefPubMed
40.
Zurück zum Zitat Leung WK, Sung JJ. Review article: intestinal metaplasia and gastric carcinogenesis. Aliment Pharmacol Ther. 2002;16:1209–1216. CrossRefPubMed Leung WK, Sung JJ. Review article: intestinal metaplasia and gastric carcinogenesis. Aliment Pharmacol Ther. 2002;16:1209–1216. CrossRefPubMed
41.
Zurück zum Zitat Kulke MH, Benson AB 3rd, Bergsland E, et al. Neuroendocrine tumors. J Natl Compr Canc Netw. 2012;10:724–764. PubMed Kulke MH, Benson AB 3rd, Bergsland E, et al. Neuroendocrine tumors. J Natl Compr Canc Netw. 2012;10:724–764. PubMed
42.
Zurück zum Zitat Hsing AW, Hansson LE, McLaughlin JK, et al. Pernicious anemia and subsequent cancer. A population-based cohort study. Cancer. 1993;71:745–750. CrossRefPubMed Hsing AW, Hansson LE, McLaughlin JK, et al. Pernicious anemia and subsequent cancer. A population-based cohort study. Cancer. 1993;71:745–750. CrossRefPubMed
43.
Zurück zum Zitat Waldum HL, Aase S, Kyetnoi I, et al. Neuroendocrine differentiation in human gastric carcinoma. Cancer. 1998;83:435–444. CrossRefPubMed Waldum HL, Aase S, Kyetnoi I, et al. Neuroendocrine differentiation in human gastric carcinoma. Cancer. 1998;83:435–444. CrossRefPubMed
44.
Metadaten
Titel
Management and Disease Outcome of Type I Gastric Neuroendocrine Tumors: The Mount Sinai Experience
verfasst von
William C. Chen
Richard R. P. Warner
Stephen C. Ward
Noam Harpaz
Celia M. Divino
Steven H. Itzkowitz
Michelle K. Kim
Publikationsdatum
01.04.2015
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 4/2015
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-014-3410-1

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