Survival and prognostic factors in patients with small bowel carcinoid tumour

• Published in: British journal of surgery Vol. 98; no. 11; pp. 1617 - 1624
• Main Authors: Landerholm, K., Zar, N., Andersson, R. E., Falkmer, S. E., Järhult, J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-11-2011; Wiley
• Subjects: Aged; Biological and medical sciences; Carcinoid Tumor - mortality; Carcinoid Tumor - surgery; Cause of Death; Disease-Free Survival; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Ileal Neoplasms - mortality; Ileal Neoplasms - surgery; Jejunal Neoplasms - mortality; Jejunal Neoplasms - surgery; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - surgery; Neoplasm, Residual - mortality; Prognosis; Reoperation; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Human; Medicine; Prognosis; Treatment; Surgery; Digestive diseases; Intestinal disease; Patient; Small bowel tumour; Survival
• ISSN: 0007-1323; 1365-2168; 1365-2168
• DOI: 10.1002/bjs.7649

Background:
Previous studies of small bowel carcinoid tumours usually presented overall or relative survival. This study, in addition, evaluated disease‐specific survival in a cohort of patients in a geographically defined population.
Methods:
Patients diagnosed with carcinoid of the jejunum or ileum in Jönköping County between 1960 and 2005 were eligible for inclusion. Available tumour specimens were re‐examined to confirm the diagnosis. Medical records and pathology reports were reviewed in detail.
Results:
A total of 145 patients were included in the study. One hundred and thirty‐five patients underwent surgery in connection with the diagnosis. Resection was considered complete (R0) in 74 patients (54·8 per cent). Only two localized tumours recurred, whereas no patient with distant metastases was cured. Patients with regional metastases who underwent R0 resection had a better survival than patients with incomplete resection (P = 0·005), and a majority of patients remained recurrence‐free. Median overall survival was 7·2 years and median disease‐specific survival 12·3 years. In multivariable analysis, age 61–74 years (hazard ratio (HR) 3·78, 95 per cent confidence interval 1·86 to 7·68), age 75 years or more (HR 3·96, 1·79 to 8·74), distant metastases (HR 14·44, 1·59 to 131·36) and incomplete tumour resection (HR 2·71, 1·11 to 6·61) were associated with worse disease‐specific survival. Later time period of diagnosis (HR 0·45, 0·24 to 0·84) was associated with better disease‐specific survival.
Conclusion:
Age, disease stage and complete resection were identified as independent prognostic factors for survival in patients with small bowel carcinoid tumours. The importance of achieving R0 resection is therefore emphasized. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Complete resection is important