title: The Influence of Preoperative Symptoms on the Death of Patients with Small Intestinal Neuroendocrine Tumors.
abstract: BACKGROUND
  Small intestinal neuroendocrine tumors (SI-NETs) are uncommon tumors with an annual incidence of about 1 per 100,000. Usually, SI-NETs have a slow progression, and patients often present with generalized disease. Many patients do well, and the disease has a relatively favorable 5-year survival rate. Some SI-NETs, however, have a more negative prognosis. This study aimed to establish prognostic factors for death identifiable at primary surgery.
  
  
  METHODS
  A nested case-control study investigated 1150 patients from the cohort of all patients with a diagnosis of SI-NETs in Sweden between 1961 and 2001. The study cases consisted of all patients who died of SI-NETs during the study period. Each case was assigned a control subject matched by age at diagnosis and calendar period. Possible prognostic factors [gender, degree of symptoms, indication for surgery, World Health Organization (WHO) stage] were evaluated in uni- and multivariable analyses.
  
  
  RESULTS
  The patients with symptomatic disease had an increased risk of dying. The indication for primary surgery influenced survival, showing a more negative prognosis for elective surgery. The WHO stage influenced survival, and stage 4 patients had an almost threefold risk of dying compared with stages 1 to 3b patients.
  
  
  CONCLUSIONS
  This study showed that preoperative symptoms are important in prognostication for SI-NETs. Hormonal symptoms generally signify a patient with a more advanced disease stage and a worse prognosis. Including symptomatic disease together with the WHO stage and grade could possibly increase the accuracy of prognostication.
authors.affiliation: Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden. john.eriksson@surgsci.uu.se.
authors.forename: John
authors.initials: J
authors.lastname: Eriksson
authors.affiliation: Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, UK/Regional Oncologic Center, Uppsala University, Uppsala, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.affiliation: Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Hellman
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
authors.forename: Catharina
authors.initials: C
authors.lastname: Ihre-Lundgren
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003949:Diagnostic Techniques, Surgical / Q000706:statistics & numerical data; D003967:Diarrhea / Q000209:etiology; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D005483:Flushing / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D007414:Intestinal Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012135:Respiratory Sounds / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D063189:Symptom Assessment