title: Appendiceal Neuroendocrine, Goblet and Signet-Ring Cell Tumors: A Spectrum of Diseases with Different Patterns of Presentation and Outcome.
abstract: OBJECTIVE
  Appendiceal tumors are a heterogeneous group of diseases that include typical neuroendocrine tumors (TNET), goblet cell carcinoids (GCC), and atypical GCC. Atypical GCC are classified into signet-ring cell cancers (SRCC) and poorly differentiated appendiceal adenocarcinoids. The prognosis and management of these diseases is unclear because there are no prospective studies. The aim of this study is to assess the characteristics and outcome of appendiceal TNET, GCC, and SRCC patients.
  
  
  METHODS
  Appendiceal TNET, GCC, and SRCC patients diagnosed between 1973 and 2011 were identified in the Surveillance Epidemiology and End Results (SEER) database. Demographics, type of surgery, and clinicopathologic characteristics were collected. Survival functions were estimated by the Kaplan-Meier method, and log-rank test was used to assess the difference in overall survival (OS) among the three histologies.
  
  
  RESULTS
  The SEER database yielded 1,021 TNET patients, 1,582 with GCC, and 534 SRCC patients. TNET presented at a younger age (p < 0.001). Patients with SRCC presented with advanced stage disease (p < 0.001). The median OS (mOS) for GCC and TNET patients was not reached; mOS for SRCC was 24 months. Multivariate analysis stratified for stage revealed significantly longer survival for TNET and GCC than SRCC (p < 0.001).
  
  
  CONCLUSIONS
  This is the largest report to date for appendiceal neuroendocrine tumor patients, suggesting a spectrum of diseases with different characteristics and outcomes. In this report, we present a treatment approach for this complex spectrum of disease, based on the experience of Ohio State and Emory Universities investigators.
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Walid
authors.initials: W
authors.lastname: Shaib
authors.affiliation: Division of Hematology Oncology, The Ohio State University, Columbus, OH, USA.
authors.forename: Kavya
authors.initials: K
authors.lastname: Krishna
authors.affiliation: Department of Biostatistics, Emory University, Atlanta, GA, USA.
authors.forename: Sungjin
authors.initials: S
authors.lastname: Kim
authors.affiliation: School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Department of Pathology, The Ohio State University, Columbus, OH, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rock
authors.affiliation: Department of Biostatistics, Emory University, Atlanta, GA, USA.
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Edith
authors.initials: E
authors.lastname: Brutcher
authors.affiliation: Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Charles Iii
authors.initials: CI
authors.lastname: Staley
authors.affiliation: Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Surgical Oncology, The Ohio State University, Columbus, OH, USA.
authors.forename: Samih
authors.initials: S
authors.lastname: Abdel-Missih
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Bassel F
authors.initials: BF
authors.lastname: El-Rayes
authors.affiliation: Division of Hematology Oncology, The Ohio State University, Columbus, OH, USA.
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001063:Appendiceal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002276:Carcinoid Tumor / Q000175:diagnosis* / Q000473:pathology; D018279:Carcinoma, Signet Ring Cell / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Appendiceal neoplasms; Disease management; Goblet cells; Neuroendocrine tumors; Signet ring; Survival