Clinical Review of Gastrointestinal Carcinoid Tumor and Analysis of the Factors Predicting Metastasis

Chang, Jae Hyuck; Kim, Sang Woo; Chung, Woo Chul; Kim, Young Chul; Jung, Chan Kwon; Paik, Chang Nyol; Park, Jae Myung; Cho, Yu Kyung; Lee, In Seok; Choi, Myung Gyu; Chung, In Sik

Abstract

BACKGROUND/AIMS: Carcinoid tumors are submucosal tumors with metastatic potential. We tried to determine the clinical course of gastrointestinal (GI) carcinoid tumors and find the factors predicting metastasis. METHODS: We reviewed the clinical records of 81 cases with GI carcinoid tumors. Involved organ, age, sex, symptoms, treatments, and metastatic patterns were reviewed. We evaluated the macroscopic and microscopic parameters to predict the metastatic potential of GI carcinoid tumors. RESULTS: The common sites of GI carcinoids were rectum (71.7%), stomach (13.6%), and duodenum (8.6%). Mean age of the patients was 49 years old with a peak incidence of sixth decade. Male to female ratio was 1.38:1. Most symptoms were usually nonspecific. Fifty five patients (67.9%) received endoscopic treatments while 23 patients (28.4%) received surgical treatment. Patients were followed up for a mean period of 15.6 months. There were 10 cases (12.3%) of metastasis. There were significantly more metastasis in patients with tumor size >10 mm (p<0.001), central depression or ulcer (p=0.009) in macroscopic parameter, and with invasion below submucosa, lymphatic or venous invasion, number of mitosis >2, or Ki-67 labeling index >2 in microscopic parameter (p<0.05). Independent factors predicting metastasis were tumor size and central depression or ulcer in multivariate analysis (p=0.002 and p=0.035, respectively). CONCLUSIONS: Patients with tumor size >10 mm, central depression or ulcer, invasion below submucosa, lymphatic or venous invasion, mitosis >2, and Ki-67 labeling index >2 have higher metastatic potential. Those with risk factors predicting metastasis should be treated and followed carefully.