Digestive calcitonin-secreting tumors of the foregut: comparison with non-calcitonin-secreting tumors.
OBJECTIVE
Digestive calcitonin-secreting endocrine tumors are very rare lesions of the foregut. This study was undertaken to compare the characteristics and the prognosis of these tumors and those of non-calcitonin-secreting endocrine tumors.


METHODS
All patients with a digestive endocrine tumor of the foregut followed up in Reims University Hospital and whose serum calcitonin levels were determined between 1988 and 2004 were included. Clinical and tumor characteristics of calcitonin-positive and calcitonin-negative patients were compared.


RESULTS
Thirty-two patients were included. Among the five (15.6%) with high calcitonin levels (median: 340 pg/ml, range: 42-7460 pg/ml), only one tumor was functioning (diarrhea). Significant differences between patients with positive and negative calcitonin levels were, respectively: liver metastases [5 (100%) versus 11 (40.7%); P=0.04], type according to the World Health Organization 2000 histological classification [notably 4 (80%) versus 3 (12.5%) poorly differentiated endocrine carcinomas; P=0.02] and Ki67 proliferation index [median: 25% (range: 20-30%) versus 7% (0-80%); P=0.03]. The only calcitonin-positive well-differentiated endocrine carcinoma had a high proliferation index (30%). Survival also differed significantly (P=0.001), as all calcitonin-positive patients died, with a median survival of 22.6 months (range: 1.2-27.2 months), versus five (18.5%) calcitonin-negative patients. Median follow-up period for the latter was 42.3 months (range: 3.4-208 months).


CONCLUSIONS
The secretion of calcitonin appears predictive of a poor prognosis. Digestive endocrine calcitonin-secreting tumors correspond histopathologically to poorly differentiated or well-differentiated carcinomas with high proliferation indexes.
Wuilmet
Laurent
L
Department of Gastroenterology, Hôpital Robert-Debré, France.
Jovenin
Nicolas
N
Larbre
Hélène
H
Lévy-Bohbot
Nathalie
N
Diebold
Marie-Danièle
MD
Jolly
Damien
D
Delemer
Brigitte
B
Thiéfin
Gérard
G
Cadiot
Guillaume
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D002116:Calcitonin / Q000097:blood / Q000378:metabolism*; D004067:Digestive System Neoplasms / Q000097:blood / Q000378:metabolism* / Q000401:mortality; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
D002116:Calcitonin