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      Current Trends of the Incidence and Pathological Diagnosis of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) in Korea 2000-2009: Multicenter Study

      research-article
      Author(s): The Gastrointestinal Pathology Study Group of Korean Society of Pathologists, , MD, PhD 1 , , MD, PhD 2 , , MD, PhD 3 , , , MD, PhD 4 , , MD, PhD 5 , , MD, PhD 6 , , MD, PhD 7 , , MD, PhD 8 , , MD, PhD 9 , , MD, PhD 10 , , MD, PhD 11 , , MD, PhD 12 , , MD, PhD 13 , , MD, PhD 14 , , MD, PhD 15 , , MD, PhD 16 , , MD, PhD 17 , , MD, PhD 18 , , MD, PhD 19 , , MD, PhD 20 , , MD, PhD 21 , , MD, PhD 22 , , MD, PhD 23 , , MD, PhD 24 , , MD, PhD 25 , , MD, PhD 26 , , MD, PhD 27 , , MD, PhD 28
      Publication date (Electronic):
      Journal: Cancer Research and Treatment : Official Journal of Korean Cancer Association
      Publisher: Korean Cancer Association
      Keywords: Gastro-enteropancreatic neuroendocrine tumor, Incidence, Prognosis, Pathology

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          Abstract

          Purpose

          As a result of various independently proposed nomenclatures and classifications, there is confusion in the diagnosis and prediction of biological behavior of gastroenteropancreatic neuroendocrine tumors (GEP-NETs). A comprehensive nationwide study is needed in order to understand the biological characteristics of GEP-NETs in Korea.

          Materials and Methods

          We collected 4,951 pathology reports from 29 hospitals in Korea between 2000 and 2009. Kaplan-Meier survival analysis was used to determine the prognostic significance of clinicopathological parameters.

          Results

          Although the GEP-NET is a relatively rare tumor in Korea, its incidence has increased during the last decade, with the most significant increase found in the rectum. The 10-year survival rate for well-differentiated endocrine tumor was 92.89%, in contrast to 85.74% in well differentiated neuroendocrine carcinoma and 34.59% in poorly differentiated neuroendocrine carcinoma. Disease related death was most common in the biliary tract (62.2%) and very rare in the rectum (5.2%). In Kaplan-Meier survival analysis, tumor location, histological classification, extent, size, mitosis, Ki-67 labeling index, synaptophysin expression, lymphovascular invasion, perineural invasion, and lymph node metastasis showed prognostic significance (p<0.05), however, chromogranin expression did not (p=0.148). The 2000 and 2010 World Health Organization (WHO) classification proposals were useful for prediction of the prognosis of GEP-NET.

          Conclusion

          The incidence of GEP-NET in Korea has shown a remarkable increase during the last decade, however, the distribution of tumors in the digestive system differs from that of western reports. Assessment of pathological parameters, including immunostaining, is crucial in understanding biological behavior of the tumor as well as predicting prognosis of patients with GEP-NET.

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          Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE).

          R. Garcia-Carbonero, J. Capdevila, G. Crespo-Herrero … (2010)
          Neuroendocrine tumors (NETs) are an unusual family of neoplasms with a wide and complex spectrum of clinical behavior. Here, we present the first report of a National Cancer Registry of gastroenteropancreatic neuroendocrine tumors from a Southern European country. Data was provided online at www.retegep.net by participating centers and assessed for internal consistency by external independent reviewers. The study cohort comprised 907 tumors. The most common tumor types were carcinoids (55%), pancreatic nonfunctional tumors (20%), metastatic NETs of unknown primary (9%), insulinomas (8%) and gastrinomas (4%). Forty-four percent presented with distant disease at diagnosis, most often those from small intestine (65%), colon (48%), rectum (40%) and pancreas (38%), being most unusual in appendix primaries (1.3%). Stage at diagnosis varied significantly according to sex, localization of primary tumor, tumor type and grade. Overall 5-year survival was 75.4% (95% confidence interval 71.3% to 79.5%) and was significantly greater in women, younger patients and patients with hormonal syndrome and early stage or lower grade tumors. Prognosis also differed according to tumor type and primary tumor site. However, stage and Ki-67 index were the only independent predictors for survival. This national database reveals relevant information regarding epidemiology, current clinical practices and prognosis of NETs in Spain, providing valuable insights that may contribute to understand regional disparities in the incidence, patterns of care and survival of this heterogeneous disease across different continents and countries.
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            Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan.

            Kazuwa Nakao, Takao Obara, Iwao Sasaki … (2010)
            There have been few epidemiological studies on gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in Japan. We examined the epidemiology of GEP-NETs [pancreatic endocrine tumors (PETs) and gastrointestinal neuroendocrine tumors (GI-NETs)] in Japan in 2005 using a nationwide stratified random sampling method. A total of 2,845 individuals received treatment for PETs. Prevalence was estimated as 2.23/100,000 with an annual onset incidence of 1.01/100,000. Non-functioning tumor (NF)-PET constituted 47.4%, followed by insulinoma (38.2%) and gastrinoma (7.9%). Distant metastases were reported in 21% patients with NF-PETs and occurred more frequently as tumor size increased (>2 cm). Multiple endocrine neoplasia type 1 (MEN-1) was detected in 10% of PETs but only in 6.1% of NF-PETs. NF-PETs were detected incidentally by physical examination in 24% patients. In 2005, an estimated 4,406 patients received treatment for GI-NETs. Prevalence was estimated as 3.45/100,000, with an annual onset incidence of 2.10/100,000. The locations of GI-NETs varied: foregut, 30.4%; midgut, 9.6%; and hindgut, 60.0%. Distant metastases were observed in 6%. Lymph node metastases occurred more frequently as tumor size increased (>1 cm). The frequency of MEN-1 complications was 1%. Physical examination revealed GI-NETs in 44% patients. The frequency of symptomatic GI-NETs was 3.4%. Interestingly, 77.1% of patients with foregut GI-NETs had type A gastritis. Our results show there are large differences in GEP-NETs between Japan and Western nations, primarily due to differences in the presence of MEN-1 in NF-PETs and the location, symptomatic status, and prevalence of malignancy in GI-NETs.
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              Updated population-based review of carcinoid tumors.

              M Maggard, Christopher O'Connell, Y Ko (2004)
              To determine the population-based incidence, anatomic distribution, and survival rates of gastrointestinal carcinoid tumors. Carcinoid tumors arise from neuroendocrine cells and may develop in almost any organ. Many textbooks and articles represent single institution studies and report varying incidence rates, anatomic distribution of tumors, and patient survival rates. Population-based statistics remain largely unknown. Data was obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results program (1973 to 1997). Incidence rates, distribution, and 5-year survival rates were analyzed. Multivariate Cox regression was used to identify predictors of survival using age, race/ethnicity, gender, and tumor characteristics (size, lymph node status, and stage). Of the 11,427 cases analyzed, the average age was 60.9 years, and 54.2% were female. The overall incidence rates for carcinoid tumors have increased significantly over the past 25 years, although rates for some sites have decreased (eg, appendix). The gastrointestinal tract accounted for 54.5% of the tumors. Within the gastrointestinal tract, the small intestine was the most common site (44.7%), followed by the rectum (19.6%), appendix (16.7%), colon (10.6%), and stomach (7.2%). The 5-year survival rates for the most common gastrointestinal sites were stomach (75.1%), small intestine (76.1%), appendix (76.3%), and rectum (87.5%). Using national, population-based cancer registry data, this study demonstrates that (1) incidence rates for carcinoid tumors have changed, (2) the most common gastrointestinal site is not the appendix (as is often quoted), but the small intestine, followed in frequency by the rectum, and (3) survival rates differ between individual anatomic sites.
              Article 0 comments Cited 111 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cancer Res Treat
                Journal ID (iso-abbrev): Cancer Res Treat
                Journal ID (publisher-id): CRT
                Title: Cancer Research and Treatment : Official Journal of Korean Cancer Association
                Publisher: Korean Cancer Association
                ISSN (Print): 1598-2998
                ISSN (Electronic): 2005-9256
                Publication date (Print): September 2012
                Publication date (Electronic): 30 September 2012
                Volume: 44
                Issue: 3
                Pages: 157-165
                Affiliations
                [1 ]Department of Pathology, Wonju Christian Hospital, Wonju, Korea.
                [2 ]Department of Pathology, Inha University Hospital, Incheon, Korea.
                [3 ]Department of Pathology, Kangbuk Samsung Medical Center, Seoul, Korea.
                [4 ]Department of Pathology, Asan Medical Center, Seoul, Korea.
                [5 ]Department of Pathology, Samsung Medical Center, Seoul, Korea.
                [6 ]Department of Pathology, Seoul National University Hospital, Seoul, Korea.
                [7 ]Department of Pathology, Severance Hospital, Seoul, Korea.
                [8 ]Department of Pathology, National Cancer Center, Goyang, Korea.
                [9 ]Department of Pathology, Pusan National University Hospital, Busan, Korea.
                [10 ]Department of Pathology, Chonnam National University Hospital, Gwangju, Korea.
                [11 ]Department of Pathology, Kosin University Gospel Hospital, Busan, Korea.
                [12 ]Department of Pathology, Seoul St. Mary's Hospital, Seoul, Korea.
                [13 ]Department of Pathology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
                [14 ]Department of Pathology, Soonchunhyang University Hospital, Seoul, Korea.
                [15 ]Department of Pathology, Yeungnam University Hospital, Daegu, Korea.
                [16 ]Department of Pathology, Daegu Fatima Hospital, Daegu, Korea.
                [17 ]Department of Pathology, Dong-A University Hospital, Busan, Korea.
                [18 ]Department of Pathology, Busan Paik Hospital, Busan, Korea.
                [19 ]Department of Pathology, Daegu Catholic University Medical Center, Daegu, Korea.
                [20 ]Department of Pathology, Konyang University Hospital, Daejeon, Korea.
                [21 ]Department of Pathology, Seoul Paik Hospital, Seoul, Korea.
                [22 ]Department of Pathology, Kyunghee University Hospital, Seoul, Korea.
                [23 ]Department of Pathology, Gangnam Severerance Hospital, Seoul, Korea.
                [24 ]Department of Pathology, Kyungpook National University Hospital, Daegu, Korea.
                [25 ]Department of Pathology, Ilsan Paik Hospital, Goyang, Korea.
                [26 ]Department of Pathology, Chonbuk National University Hospital, Jeonju, Korea.
                [27 ]Department of Pathology, Chungnam National University Hospital, Daejeon, Korea.
                [28 ]Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
                Author notes
                Correspondence: Jin Hee Sohn, MD, PhD. Department of Pathology, Kangbuk Samsung Hospital, Sungkyungkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 110-746, Korea. Tel: 82-2-2001-2391, Fax: 82-2-2001-2398, jhpath.sohn@ 123456samsung.com

                *Present address: Mi-Jung Kim 4: Daehang Hospital, Seoul, Korea. Mi Jin Gu 16: Yeungnam University Hospital, Daegu, Korea.

                Article
                DOI: 10.4143/crt.2012.44.3.157
                PMC ID: 3467418
                PubMed ID: 23091441
                SO-VID: 097a88dd-db02-4af2-9f26-20518f8de530
                Copyright © Copyright © 2012 by the Korean Cancer Association
                License:

                This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 July 2012
                Date accepted : 07 August 2012
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: pathology,gastro-enteropancreatic neuroendocrine tumor,prognosis,incidence
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: pathology, gastro-enteropancreatic neuroendocrine tumor, prognosis, incidence

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