title: Foregut carcinoids: a clinical and biochemical analysis.
abstract: BACKGROUND
  Gastrointestinal foregut carcinoids make up a small percentage (3% to 6%) of all reported carcinoids. Because these tumors are so uncommon, comparisons between the subtypes have been difficult. The goal of this study was to compare the hormonal and clinical characteristics of gastric, duodenal, and pancreatic carcinoids.
  
  
  METHODS
  A prospective database of approximately 750 carcinoid patients seen by one author over 25 years was reviewed, and the 104 patients with gastric (33), duodenal (17), or pancreatic (54) carcinoids were selected as the subgroup for analysis. These patients were compared with regard to hormone levels, clinical course, treatment, and survival.
  
  
  RESULTS
  Duodenal carcinoids exhibited significantly lower serotoninergic hormone levels than did the gastric and pancreatic carcinoids (urine 5-hydroxyindoleacetic acid [mg/24 h], 5 +/- 1 vs 16 +/- 5 and 47 +/- 12, respectively, P = .03). Pancreatic carcinoids presented with more advanced stage (distant metastases 87% vs 42% and 20% for gastric and duodenal, respectively) and had worse outcomes than patients with gastric and duodenal tumors with 10-year survivals of 10%, 59%, and 58%, respectively (P = .003).
  
  
  CONCLUSIONS
  Pancreatic carcinoids produce higher levels of serotoninergic hormones and have a significantly higher stage and worse outcome than other foregut carcinoids. This study demonstrates that the organ of origin is an important determinant of hormonal activity and clinical course for patients with foregut carcinoids.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Kirshbom
authors.forename: A R
authors.initials: AR
authors.lastname: Kherani
authors.forename: M W
authors.initials: MW
authors.lastname: Onaitis
authors.forename: A
authors.initials: A
authors.lastname: Hata
authors.forename: T E
authors.initials: TE
authors.lastname: Kehoe
authors.forename: C
authors.initials: C
authors.lastname: Feldman
authors.forename: J M
authors.initials: JM
authors.lastname: Feldman
authors.forename: D S
authors.initials: DS
authors.lastname: Tyler
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D002276:Carcinoid Tumor / Q000737:chemistry* / Q000175:diagnosis* / Q000401:mortality; D004379:Duodenal Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000737:chemistry* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D012701:Serotonin / Q000097:blood; D017678:Sex Distribution; D013274:Stomach Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000401:mortality; D016019:Survival Analysis
chemical_list: D012701:Serotonin; D006897:Hydroxyindoleacetic Acid