title: Jejunoileal Neuroendocrine Tumors Complicated by Intestinal Ischemic Necrosis Are Associated With Worse Overall Survival.
abstract: BACKGROUND
  -Jejunoileal neuroendocrine tumors (JINETs) are slow-growing, malignant tumors that are often associated with protracted survival, despite their frequent presentation at an advanced stage. A subset of JINETs is complicated by intestinal ischemic necrosis (IIN), which leads to their initial clinical presentation.
  
  
  OBJECTIVE
  -To assess the effect of IIN on overall survival in patients with JINETs.
  
  
  METHODS
  -Ten JINETs with IIN during a 14-year period and a control group of 52 JINETs without IIN were identified retrospectively. The hematoxylin-eosin slides and gross descriptions were reviewed, and pathologic features were assessed. Overall survival was compared between the 2 groups using the Kaplan Meier method and Cox proportional hazards model.
  
  
  RESULTS
  -At 1 year postresection, only 40% (4 of 10) of the patients with IIN were alive, whereas 94% (49 of 52) of those without IIN were alive (P < .001). Patients with IIN were significantly older than those without IIN (median, 83 years versus 65.5 years, P = .001). By univariate Cox proportional hazards regression, IIN was associated with a 4.30-fold increased risk of death (95% confidence interval 1.75-10.56; P = .001). When controlling for age, advanced stage (stage III or IV), tumor grade, and synchronous carcinoma in a multivariate analysis, IIN showed a trend toward prognostic significance (2.31-fold increased risk of death; 95% confidence interval, 0.85-6.27; P = .10).
  
  
  CONCLUSIONS
  -The pathologic identification of tumor-associated IIN portends a worse overall survival among patients with JINETs.
authors.forename: Michael
authors.initials: M
authors.lastname: Landau
authors.forename: Stephen
authors.initials: S
authors.lastname: Wisniewski
authors.affiliation: From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Landau and Davison); and the Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh (Dr Wisniewski).
authors.forename: Jon
authors.initials: J
authors.lastname: Davison
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D007422:Intestines / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D007511:Ischemia / Q000150:complications* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D007580:Jejunal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis