TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system

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Abstract

The need for standards in the management of patients with endocrine tumors of the digestive system prompted the European Neuroendocrine Tumor Society (ENETS) to organize a first Consensus Conference, which was held in Frascati (Rome) and was based on the recently published ENETS guidelines on the diagnosis and treatment of digestive neuroendocrine tumors (NET). Here, we report the tumor–node–metastasis proposal for foregut NETs of the stomach, duodenum, and pancreas that was designed, discussed, and consensually approved at this conference. In addition, we report the proposal for a working formulation for the grading of digestive NETs based on mitotic count and Ki-67 index. This proposal, which needs to be validated, is meant to help clinicians in the stratification, treatment, and follow-up of patients.

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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.

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Guidelines for the Diagnosis and Treatment of Neuroendocrine Gastrointestinal Tumours

U Plöckinger, G. Rindi, R. Arnold … (2005)

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Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system.

K Oberg, L. Kvols, M. Caplin … (2004)

This consensus report gives a detailed description of the use of somatostatin analogs in the management of neuroendocrine tumors of the gastroenteropancreatic system. As background information we have outlined critical aspects of the pathology, the use of tumor markers, a definition of functional and non-functional digestive neuroendocrine tumors, different imaging modalities, surgical considerations, liver embolization and the use of cytotoxic drugs as well as interferon. Included in the report is an overview of somatostatin, somatostatin analogs and its receptor expression in different neuroendocrine tumors. It will also define the binding affinities of different somatostatin analogs to the five different subtypes of somatostatin receptor. We compare the efficacy of octreotide and lanreotide in reducing diarrhea and flushing. Side-effects are described and we provide practical information on somatostatin analog treatment.

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: +39-0521-702636 , +39-0521-292710 , guido.rindi@unipr.it

Journal

Journal ID (nlm-ta): Virchows Arch

Title: Virchows Archiv

Publisher: Springer-Verlag (Berlin/Heidelberg )

ISSN (Print): 0945-6317

ISSN (Electronic): 1432-2307

Publication date (Electronic): 12 September 2006

Publication date (Print): October 2006

Volume: 449

Issue: 4

Pages: 395-401

Affiliations

[1 ]Dipartimento di Patologia e, Medicina di Laboratorio, Sezione di Anatomia Patologica, Università di Parma, Via Gramsci, 14, 43100 Parma, Italy

[2 ]Department of Pathology, University of Kiel, Kiel, Germany

[3 ]Department of Surgery, Gothenburg University, Gothenburg, Sweden

[4 ]Department of Internal Medicine, Royal Free Hospital, London, UK

[5 ]Department of Pathology, Hôpital Beaujon, Clichy, France

[6 ]Department of Internal Medicine, Erasmus, Rotterdam The Netherlands

[7 ]Department of Endocrinology, University Hospital, Uppsala, Sweden

[8 ]Department of Internal Medicine, University of Florence, Florence, Italy

[9 ]Department of Surgery, University of Verona, Verona, Italy

[10 ]Department of Pathology, Kantosspital Baden, Baden, Switzerland

[11 ]Department of Pathology, University of Bern, Bern, Switzerland

[12 ]Department of Pathology, Porto Medical School and IPATIMUP, University of Porto, Porto, Portugal

[13 ]Department of Pathology, Glasgow Royal Infirmary, Glasgow, Scotland UK

[14 ]Department of Pathology, Gothenborg University, Gothenburg, Sweden

[15 ]Department of Pathology, Universitätsspital Zürich, Zürich, Switzerland

[16 ]Department of Pathology, University of Verona, Verona, Italy

[17 ]Department of Pathology, University of Lyon, Lyon, France

[18 ]Department of Internal Medicine, Campus Virchow Klinikum, Berlin, Germany

Article

Publisher ID: 250

DOI: 10.1007/s00428-006-0250-1

PMC ID: 1888719

PubMed ID: 16967267

SO-VID: 80ed9bc3-671a-462b-825d-26fc291c45af

History

Date received : 11 April 2006

Date accepted : 6 June 2006

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ScienceOpen disciplines: Pathology

Keywords: grading,neuroendocrine tumors,mitotic index,staging,pancreas,ki-67 index,gut,tnm

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ScienceOpen disciplines: Pathology

Keywords: grading, neuroendocrine tumors, mitotic index, staging, pancreas, ki-67 index, gut, tnm

TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system

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Karger: Ophthalmology

Most cited references 31

Updated population-based review of carcinoid tumors.

Guidelines for the Diagnosis and Treatment of Neuroendocrine Gastrointestinal Tumours

Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system.

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