Treatment of gastric neuroendocrine tumors: the necessity of a type-adapted treatment.
BACKGROUND
Gastric neuroendocrine (or gastric carcinoid) tumors have recently been classified into 3 types that differ in biological behavior and prognosis. Although the necessity of type-adapted treatment is widely accepted, it seems inconsistently used in daily practice.


OBJECTIVE
Diagnostic differentiation into various biological types is necessary for an adequate treatment of gastric neuroendocrine tumors.


METHODS
Retrospective study.


METHODS
University hospital department of surgery.


METHODS
Twenty-seven patients with a histologically verified gastric neuroendocrine tumor.


METHODS
A univariate analysis of survival rates with respect to tumor type, tumor biological parameters, and treatment performed was accomplished by applying the Kaplan-Meier estimation method. The log-rank test was used to evaluate the level of significance.


RESULTS
The 16 type 1 (59%) and 11 type 3 (41%) gastric neuroendocrine tumors differ in tumor size, histopathologic characteristics, and biological behavior. Nine (56%) of 16 type 1 gastric neuroendocrine tumors were treated by local excision, 8 of these (89%) had persistent atrophic gastropathy during the follow-up period. Five-year cumulative survival of patients with type 1 gastric neuroendocrine tumor was 100% without any progression into malignant phenotype. In contrast, 4 (44%) of 9 locally advanced type 3 gastric neuroendocrine tumors were treated radically by extended resection with a 5-year cumulative survival of 75%.


CONCLUSIONS
Differentiation into 3 biologically distinct tumor types for gastric neuroendocrine tumors is important with respect to therapeutic strategy and prognostic consideration. Correct diagnosis is attainable by using endoscopy, histopathologic characteristics, and laboratory chemical analysis and should precede any treatment. Extended radical surgery of high-risk type 3 tumors is indicated when definitive healing is achievable, whereas type 1 tumors are best treated by endoscopic removal and long-term follow-up.
Schindl
M
M
Department of Surgery, Division of General Surgery, Section Endocrine Surgery University of Vienna Medical School, Währinger Gürtel 18-20, A 1090 Vienna, Austria.
Kaserer
K
K
Niederle
B
B
D002276:Carcinoid Tumor / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors