title: Clinically detected gastroenteropancreatic neuroendocrine tumors are on the rise: epidemiological changes in Germany.
abstract: OBJECTIVE
  To study the epidemiologic changes of gastroenteropancreatic neuroendocrine tumors (GEP-NET) in Germany, we analyzed two time periods 1976-1988 and 1998-2006.
  
  
  METHODS
  We evaluated epidemiological data of GEP-NET from the former East German National Cancer Registry (DDR Krebsregister, 1976-1988) and its successor, the Joint Cancer Registry (GKR, 1998-2006), which was founded after German reunification. Due to a particularly substantial database the epidemiological data from the federal states of Mecklenburg-Western Pomerania, Saxony, Brandenburg and Thuringia, covering a population of more than 10.8 million people, were analyzed. Survival probabilities were calculated using life table analysis. In addition, GEP-NET patients were evaluated for one or more second (non-GEP-NET) primary malignancies.
  
  
  RESULTS
  A total of 2821 GEP neuroendocrine neoplasms were identified in the two registries. The overall incidence increased significantly between 1976 and 2006 from 0.31 (per 100.000 inhabitants per year) to 2.27 for men and from 0.57 to 2.38 for women. In the later period studied (2004-2006), the small intestine was the most common site. Neuroendocrine (NE) neoplasms of the small intestine showed the largest absolute increase in incidence, while rectal NE neoplasms exhibited the greatest relative increase. Only the incidence of appendiceal NET in women showed little change between 1976 and 2006. Overall survival of patients varied for sex, tumor site and the two periods studied but improved significantly over time. Interestingly, about 20% of the GEP-NET patients developed one or more second malignancies. Their most common location was the gastrointestinal tract. GEP-NET patients without second malignancies fared better than those with one or more of them.
  
  
  CONCLUSIONS
  The number of detected GEP-NET increased about 5-fold in Germany between 1976 and 2006. At the same time, their anatomic distribution changed, and the survival of GEP-NET patients improved significantly. Second malignancies are common and influence the overall survival of GEP-NET patients. Thus, GEP-NET warrant our attention as well as intensive research on their tumorigenesis.
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Scherübl
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Streller
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Stabenow
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Herbst
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Höpfner
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwertner
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Steinberg
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Eick
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Wanda
authors.initials: W
authors.lastname: Ring
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Krishna
authors.initials: K
authors.lastname: Tiwari
authors.affiliation: Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
authors.forename: Sören M
authors.initials: SM
authors.lastname: Zappe
mesh_terms: D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007414:Intestinal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015993:Life Tables; D008297:Male; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012042:Registries; D017678:Sex Distribution; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors
keywords: Endoscopy; Epidemiology; Gastrinoma; German history; Insulinoma; Neuroendocrine; Reunification; Second malignancy; Tumor