Endoscopically identified well-differentiated rectal carcinoid tumors

Impact of tumor size on the natural history and outcomes

Ferga C. Gleeson, Michael J. Levy, Eric Dozois, David Larson, Louis Michel Wong Kee Song, Lisa Allyn Boardman

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background There is a paucity of data pertaining to the natural history and outcomes of patients with well-differentiated rectal carcinoids. Objective To correlate endoscopic size with the natural history and outcome. Design Retrospective study. Setting Single tertiary referral center. Patients Eighty-seven patients with endoscopically identified well-differentiated rectal carcinoid tumors. Intervention Colonoscopy. Main Outcome Measurements Prevalence of metastasis at diagnosis, disease progression, and survival. Results Metastasis was present at diagnosis in 3%, 66%, and 73% of tumors measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. Metastasis was predicted with 100% sensitivity and 87% specificity using an endoscopic lesion size ≥9 mm. In patients without identified metastasis, 64% were identified during screening colonoscopy. Within this select cohort, subsequent metastasis was discovered only at distant extra pelvic sites, in 1.6%, 50%, and 100% of patients with tumors initially measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. The carcinoid related 5- and 10-year survival rates for locally confined disease were 96%. The corresponding survival rates for local and advanced metastatic disease were 60% and 35%, respectively. Limitations Subjective estimation of tumor size, mitotic index or Ki-67 labeling index not reported, and lack of formal and standardized baseline staging algorithm and surveillance program. Conclusions The clinical behavior of 11- to 19-mm tumors appears to mimic that of larger (>20 mm) lesions with respect to the presence of metastasis at diagnosis and disease progression. Therefore, if local therapy is contemplated, we propose to make a distinction between ≤10-mm and 11- to 19-mm tumors, favoring an aggressive staging and management protocol for 11- to 19-mm carcinoid tumors.

Original languageEnglish (US)
Pages (from-to)144-151
Number of pages8
JournalGastrointestinal Endoscopy
Volume80
Issue number1
DOIs
StatePublished - 2014

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Carcinoid Tumor
Rectal Neoplasms
Natural History
Neoplasm Metastasis
Neoplasms
Colonoscopy
Disease Progression
Survival Rate
Mitotic Index
Tertiary Care Centers
Retrospective Studies
Sensitivity and Specificity
Survival

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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Endoscopically identified well-differentiated rectal carcinoid tumors : Impact of tumor size on the natural history and outcomes. / Gleeson, Ferga C.; Levy, Michael J.; Dozois, Eric; Larson, David; Wong Kee Song, Louis Michel; Boardman, Lisa Allyn.

In: Gastrointestinal Endoscopy, Vol. 80, No. 1, 2014, p. 144-151.

Research output: Contribution to journalArticle

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abstract = "Background There is a paucity of data pertaining to the natural history and outcomes of patients with well-differentiated rectal carcinoids. Objective To correlate endoscopic size with the natural history and outcome. Design Retrospective study. Setting Single tertiary referral center. Patients Eighty-seven patients with endoscopically identified well-differentiated rectal carcinoid tumors. Intervention Colonoscopy. Main Outcome Measurements Prevalence of metastasis at diagnosis, disease progression, and survival. Results Metastasis was present at diagnosis in 3{\%}, 66{\%}, and 73{\%} of tumors measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. Metastasis was predicted with 100{\%} sensitivity and 87{\%} specificity using an endoscopic lesion size ≥9 mm. In patients without identified metastasis, 64{\%} were identified during screening colonoscopy. Within this select cohort, subsequent metastasis was discovered only at distant extra pelvic sites, in 1.6{\%}, 50{\%}, and 100{\%} of patients with tumors initially measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. The carcinoid related 5- and 10-year survival rates for locally confined disease were 96{\%}. The corresponding survival rates for local and advanced metastatic disease were 60{\%} and 35{\%}, respectively. Limitations Subjective estimation of tumor size, mitotic index or Ki-67 labeling index not reported, and lack of formal and standardized baseline staging algorithm and surveillance program. Conclusions The clinical behavior of 11- to 19-mm tumors appears to mimic that of larger (>20 mm) lesions with respect to the presence of metastasis at diagnosis and disease progression. Therefore, if local therapy is contemplated, we propose to make a distinction between ≤10-mm and 11- to 19-mm tumors, favoring an aggressive staging and management protocol for 11- to 19-mm carcinoid tumors.",
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AU - Larson, David

AU - Wong Kee Song, Louis Michel

AU - Boardman, Lisa Allyn

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N2 - Background There is a paucity of data pertaining to the natural history and outcomes of patients with well-differentiated rectal carcinoids. Objective To correlate endoscopic size with the natural history and outcome. Design Retrospective study. Setting Single tertiary referral center. Patients Eighty-seven patients with endoscopically identified well-differentiated rectal carcinoid tumors. Intervention Colonoscopy. Main Outcome Measurements Prevalence of metastasis at diagnosis, disease progression, and survival. Results Metastasis was present at diagnosis in 3%, 66%, and 73% of tumors measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. Metastasis was predicted with 100% sensitivity and 87% specificity using an endoscopic lesion size ≥9 mm. In patients without identified metastasis, 64% were identified during screening colonoscopy. Within this select cohort, subsequent metastasis was discovered only at distant extra pelvic sites, in 1.6%, 50%, and 100% of patients with tumors initially measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. The carcinoid related 5- and 10-year survival rates for locally confined disease were 96%. The corresponding survival rates for local and advanced metastatic disease were 60% and 35%, respectively. Limitations Subjective estimation of tumor size, mitotic index or Ki-67 labeling index not reported, and lack of formal and standardized baseline staging algorithm and surveillance program. Conclusions The clinical behavior of 11- to 19-mm tumors appears to mimic that of larger (>20 mm) lesions with respect to the presence of metastasis at diagnosis and disease progression. Therefore, if local therapy is contemplated, we propose to make a distinction between ≤10-mm and 11- to 19-mm tumors, favoring an aggressive staging and management protocol for 11- to 19-mm carcinoid tumors.

AB - Background There is a paucity of data pertaining to the natural history and outcomes of patients with well-differentiated rectal carcinoids. Objective To correlate endoscopic size with the natural history and outcome. Design Retrospective study. Setting Single tertiary referral center. Patients Eighty-seven patients with endoscopically identified well-differentiated rectal carcinoid tumors. Intervention Colonoscopy. Main Outcome Measurements Prevalence of metastasis at diagnosis, disease progression, and survival. Results Metastasis was present at diagnosis in 3%, 66%, and 73% of tumors measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. Metastasis was predicted with 100% sensitivity and 87% specificity using an endoscopic lesion size ≥9 mm. In patients without identified metastasis, 64% were identified during screening colonoscopy. Within this select cohort, subsequent metastasis was discovered only at distant extra pelvic sites, in 1.6%, 50%, and 100% of patients with tumors initially measuring ≤10 mm, 11 to 19 mm, and ≥20 mm, respectively. The carcinoid related 5- and 10-year survival rates for locally confined disease were 96%. The corresponding survival rates for local and advanced metastatic disease were 60% and 35%, respectively. Limitations Subjective estimation of tumor size, mitotic index or Ki-67 labeling index not reported, and lack of formal and standardized baseline staging algorithm and surveillance program. Conclusions The clinical behavior of 11- to 19-mm tumors appears to mimic that of larger (>20 mm) lesions with respect to the presence of metastasis at diagnosis and disease progression. Therefore, if local therapy is contemplated, we propose to make a distinction between ≤10-mm and 11- to 19-mm tumors, favoring an aggressive staging and management protocol for 11- to 19-mm carcinoid tumors.

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