A population-based study of outcomes in patients with gastrointestinal neuroendocrine tumours.
BACKGROUND
Neuroendocrine tumours (NETs) are heterogeneous, with varying presentations and treatment options. To our knowledge, there are no randomized and few long-term studies of patient outcomes. The role of surgical and medical therapy for local, regional and metastatic disease continues to be evaluated in the literature.


METHODS
We conducted a population-based search of the provincial cancer registry to identify patients with gastrointestinal NETs from the stomach, small intestine, colon and rectum diagnosed between 1990 and 2005 and assessed their outcomes.


RESULTS
We examined clinicopathological information on the outcomes of 530 patients with gastrointestinal NETs. The overall incidence of NETs increased from 11 per million to 19 per million during the study period. Advancing stage and patient age were associated with poor overall or disease-specific outcomes. Surgery, both curative and palliative, was associated with decreased risk of overall (hazard ratio [HR] 0.5,p< 0.001) and disease-specific (HR 0.5,p< 0.001) death. The biggest benefit was observed in patients with distant disease, in whom 5-year disease-specific survival for R0 resections was nearly double that for patients with macroscopic residual disease (92% v. 48%,p= 0.009). Older age was associated with poor 5-year overall and disease-specific survival (p< 0.001).


CONCLUSIONS
There has been a significant increase in incidence of gastrointestinal NETs, and advancing patient age, but not sex, is linked to poor outcomes in terms of overall and disease-specific survival. Surgery, both curative and palliative, was associated with decreased risk of overall and disease-specific death. Compared with patients with residual macroscopic disease, patients with distant disease were nearly twice as likely to survive 5 years if they had R0 resections. The use of radioisotope therapy and long-acting octreotide therapy was also associated with improved outcomes overall.
From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan).
Todd
T
McMullen
From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan).
Akram
A
Al-Jahdali
From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan).
Christopher
C
de Gara
From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan).
Sunita
S
Ghosh
From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan).
Alexander
A
McEwan
From the Division of General Surgery, University of Alberta, Edmonton, Alta. (McMullen, de Gara, Schiller); the Division of Pediatric Surgery, University of Dammam, Saudi Arabia (Al-Jahdali); the Department of Biostatistics and Epidemiology, Cross Cancer Institute, Edmonton, Alta. (Ghosh); and the Department of Oncologic Imaging, Cross Cancer Institute, Edmonton, Alta. (McEwan).
Daniel
D
Schiller
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D055815:Young Adult