Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Aug 27, 2013; 5(8): 239-244
Published online Aug 27, 2013. doi: 10.4240/wjgs.v5.i8.239
Small bowel carcinoid: Location isn’t everything!
Danielle M Hari, Stephanie L Goff, Heidi J Reich, Anna M Leung, Myung-Shin Sim, Ji Hey Lee, Edward Wolin, Farin Amersi
Danielle M Hari, Anna M Leung, Gastrointestinal Research Program, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA 90404, United States
Stephanie L Goff, Dana-Farber Cancer Institute, Boston, MA 02215, United States
Heidi J Reich, Edward Wolin, Farin Amersi, Division of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Myung-Shin Sim, Ji Hey Lee, Department of Biostatistics, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA 90404, United States
Author contributions: Hari DM, Sim MS, Lee JH and Amersi F contributed to data collection and study design. Sim MS and Lee JH performed statistical analyses, all authors contributed equally to writing and editing the manuscript.
Supported by Cedars-Sinai Medical Center Department of Surgical Oncology and by Fellowship Funding from the William Randolph Hearst Foundation (San Francisco, CA) (Dr. Hari DM) and the Harold McAlister Charitable Foundation (Los Angeles, CA) (Dr. Leung AM)
Correspondence to: Farin Amersi, MD, Division of Surgical Oncology, Cedars Sinai Medical Center, 8700 Beverly Blvd AC-1046A, Los Angeles, CA 90048, United States. farin.amersi@cshs.org
Telephone: +1-310-4230267 Fax: +1-310-4237596
Received: May 3, 2013
Revised: June 18, 2013
Accepted: August 12, 2013
Published online: August 27, 2013
Abstract

AIM: To investigate the prognostic significance of the primary site of disease for small bowel carcinoid (SBC) using a population-based analysis.

METHODS: The Surveillance, Epidemiology and End Results (SEER) database was queried for histologically confirmed SBC between the years 1988 and 2009. Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan-Meier method and compared using Log rank testing. Log rank and multivariate Cox regression analyses were used to identify predictors of survival using age, year of diagnosis, race, gender, tumor histology/size/location, tumor-node-metastasis stage, number of lymph nodes (LNs) examined and percent of LNs with metastases.

RESULTS: Of the 3763 patients, 51.2% were male with a mean age of 62.13 years. Median follow-up was 50 mo. The 10-year OS and DSS for duodenal primaries were significantly better when compared to jejunal and ileal primaries (P = 0.02 and < 0.0001, respectively). On multivariate Cox regression analysis, after adjusting for multiple factors, primary site location was not a significant predictor of survival (P = 0.752 for OS and P = 0.966 DSS) while age, number of primaries, number of LNs examined, T-stage and M-stage were independent predictors of survival.

CONCLUSION: This 21-year, population-based study of SBC challenges the concept that location of the primary lesion alone is a significant predictor of survival.

Keywords: Small bowel carcinoid, Primary tumor location, Survival, Prognosis, National Comprehensive Cancer network guidelines

Core tip: Duodenal carcinoids have a significantly better overall survival than jejunal and ileal carcinoids; however, location of small bowel carcinoid is not an independent predictor of survival.