Endoscopically identified well-differentiated rectal carcinoid tumors: impact of tumor size on the natural history and outcomes.
Gastrointest Endosc
; 80(1): 144-51, 2014 Jul.
Article
em En
| MEDLINE
| ID: mdl-24462168
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.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Retais
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Tumor Carcinoide
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Colonoscopia
Tipo de estudo:
Diagnostic_studies
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Evaluation_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article