Metastatic type 1 gastric carcinoid: A real threat or just a myth?

Table 1 Clinical and histopathological characteristics of the study patients

Patient No.	No. of lesions	Size, largest lesion (mm)	Ki-67%	CT before Tx	SRS/68Ga before Tx	Distant mets	Gastrin (40-108 mU/L)		Surgery	Residual disease	SSA/monthly dosage (mg)	Outcome	F/U Period (mo)
							at Dx	Last
1	multiple	15	2%	-	Uptake (stomach, LN)	no	1811	125	wedge resection	no	Som A 90	cure	108
2	solitary	35	2%	Liver mets	Uptake (stomach, Liver)	liver	-	-	Billroth 2 + LN	liver	no	SD	84
3	multiple	21	2%	Liver mets	Uptake (stomach, Liver)	liver	2204	325	none	liver	San LAR 30	CR	36
4	multiple	55	20%	Stomach lesion	Uptake (stomach)	diaphragm	1800	-	Billroth 2 + LN	no	San LAR 30	cure	24
5	multiple	25	1%	Stomach lesion	Uptake (stomach, LN)	no	1403	-	Billroth 2 + LN	no	no	cure	18
6	multiple	-	15%	Hepato-gastric ligament LN	no data	no	-	-	ER	no	no	cure	12
7	solitary	17	4%	LN	Uptake (stomach, LN)	no	700	600	wedge resection	no	no	cure	132
8	multiple	15	1%	Liver mets and LN	Uptake (LN, Liver)	liver	407	190	ER, largest	liver	San LAR 30 + INF 50 mcg/wk	PR	36
9	solitary	10	1%	Liver mets and LN	no data	liver	-	-	wedge resection	no	no	cure	360
10	solitary	30	5%	Stomach lesion	no uptake	no	5130	43	Billroth 2 + LN	no	none	cure	120
11	multiple	17	1%	-	no uptake	no	-	-	Billroth 2 + LN	no	none	cure	168
12	multiple	14	5%	-	no uptake	no	-	-	Billroth 2 + LN	no	none	cure	72
13	solitary	47	15%	-	Uptake (stomach, Liver)	liver	5470	45	ER	liver	none	SD	120
14	multiple	30	2%	-	Uptake (LN, Liver)	liver	1336	335	ER, recurrent	liver	none	SD	48
15	multiple	10	2%	No pathology	no uptake	no	3500	-	Billroth 2 + LN	no	none	cure	48
16	multiple	30	2%	Stomach lesion	no data	no	-	-	Billroth 2 + LN	no	none	cure	36
17	solitary	-	1%	Liver mets	Uptake (liver)	liver	1612	10	Billroth 2 + LN	liver	none	SD	36
18	multiple	20	-	Stomach lesion, mesenteric and gastro-hepatic LN	no data	no	506	-	wedge resection	no	none	cure	60
19	multiple	20	-	No pathology	no uptake	no	1600	-	Billroth 2 + LN	no	none	cure	72
20	multiple	15	-	Liver mets	Uptake (stomach, Liver)	liver	458	336	ER	liver	San LAR 30	SD	72

Nr. of lesions, solitary: one lesion seen on endoscopy, multiples ≥ 2 lesions seen on endoscopy; CT: Computerized tomography; SRS: Somatostatin receptor scintigraphy (Octreoscan); (68)Ga: (68)Gallium-DOTA-TATE/-TOC/-NOC PET; Tx: Treatment; SSAs: Somatostatin analogues; LN: Lymphadenopathy; mets: Metastases; SomA: Somatuline Autogel; SanLAR: Sandostatin LAR; INF: Interferon α; Billroth 2 + LN: Gastro-jejunostomy and lymph nodes dissection; wedge resection: wedge resection (triangular resection) of a part of the stomach; ER: Endoscopic resection; SD: Stable disease; PR: Partial response; CR: Complete response.

Table 2 Factors of significance in the suspicion of metastatic gastric carcinoid type 1 n (%)

Characteristics	All GCA1 patients (n = 254)	Metastatic GCA1 patients (n = 20)	P value at diagnosis (metastatic vs all GCA1)
Age (yr), mean ± SD	58.5 ± 12.7	55.1 ± 12.8	0.050
Size of largest tumor (mm, mean ± SD)	7.9 ± 12.1	20.14 ± 11	< 0.001
Ki-67 (%, mean ± SD)	1.9 ± 2.4	6.8 ± 11.2	< 0.001
Symptomatic	112 (44)	18 (90)	< 0.001
Gastrin levels (mI/L, mean ± SD) at diagnosis	898 ± 418	2138.4 ± 1562	< 0.001

GCA1: Gastric carcinoid type 1.

Table 3 Demographic and clinical characteristics of the patients included in the study n (%)

Characteristics	All patients n = 20
Age (yr), mean ± SD	55.1 ± 12.8
Male:female, n	9:11
Caucasians	95%
Size of primary tumor (mm), mean ± SD	20.14 ± 11
Symptomatic	18 (90)
Atrophic gastritis	20 (100)
Other autoimmune diseases	2 (10)
Familial aggregation	3 (15)

Table 4 Features associated with the diagnosis of gastric carcinoid type 1 in our patients

Patient No.	Vitamin B12 levels (n. 180-670 pmol/L)	APCA	Gastrin levels (n. 40-108 mU/L)	Prior use of PPIs	1st gastroscopy (macroscopic)	Histo-pathology	H.Pylori
1	45	positive (1/20)	1811	no	multiple	CAG + IM	negative
2	165	positive	-	no	solitary	CAG + IM + NECH	-
3	333	positive (1:160)	2204	no	multiple	CAG + NECH	negative
4	186	positive (1:20)	1800	no	multiple	CAG + NECH	negative
5	104	positive (1:20)	1403	no	multiple	CAG + NECH	negative
6	122	positive (1:80)	-	no	multiple	CAG	-
7	121	-	700	no	solitary	CAG + IM + NECH	-
8	86	-	407	no	multiple	CAG + IM + NECH	-
9	50	-	-	no	solitary	CAG + NECH	-
10	-	positive (1:40)	5130	no	solitary	CAG	-
11	-	-	-	no	multiple	CAG	-
12	-	-	-	no	multiple	CAG	-
13	184	positive (1:160)	5470	no	solitary	CAG	-
14	121	positive	1336	no	multiple	CAG	-
15	215	-	3500	no	multiple	CAG	-
16	-	-	-	no	multiple	CAG + IM + NECH	-
17	345	-	1612	no	solitary	CAG	-
18	130	-	506	no	multiple	CAG	-
19	181	-	1600	no	multiple	CAG	negative
20	167	positive	458	no	multiple	CAG	-

APCA: Antiparietal cells antibodies; PPIs: Proton pump inhibitors; CAG: Chronic atrophic gastritis; IM: Intestinal metaplasia; NECH: Neuroendocrine cells hyperplasia; H. pylori: Helicobacter pylori.