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Treatment of Gastric Neuroendocrine Tumors
The Necessity of a Type-Adapted Treatment
Martin Schindl, MD;
Klaus Kaserer, MD;
Bruno Niederle, MD
Arch Surg. 2001;136:49-54.
Background Gastric neuroendocrine (or gastric carcinoid) tumors have recently been classified into 3 types that differ in biological behavior and prognosis. Although the necessity of type-adapted treatment is widely accepted, it seems inconsistently used in daily practice.
Hypothesis Diagnostic differentiation into various biological types is necessary for an adequate treatment of gastric neuroendocrine tumors.
Design Retrospective study.
Setting University hospital department of surgery.
Patients Twenty-seven patients with a histologically verified gastric neuroendocrine tumor.
Main Outcome Measures A univariate analysis of survival rates with respect to tumor type, tumor biological parameters, and treatment performed was accomplished by applying the Kaplan-Meier estimation method. The log-rank test was used to evaluate the level of significance.
Results The 16 type 1 (59%) and 11 type 3 (41%) gastric neuroendocrine tumors differ in tumor size, histopathologic characteristics, and biological behavior. Nine (56%) of 16 type 1 gastric neuroendocrine tumors were treated by local excision, 8 of these (89%) had persistent atrophic gastropathy during the follow-up period. Five-year cumulative survival of patients with type 1 gastric neuroendocrine tumor was 100% without any progression into malignant phenotype. In contrast, 4 (44%) of 9 locally advanced type 3 gastric neuroendocrine tumors were treated radically by extended resection with a 5-year cumulative survival of 75%.
Conclusions Differentiation into 3 biologically distinct tumor types for gastric neuroendocrine tumors is important with respect to therapeutic strategy and prognostic consideration. Correct diagnosis is attainable by using endoscopy, histopathologic characteristics, and laboratory chemical analysis and should precede any treatment. Extended radical surgery of high-risk type 3 tumors is indicated when definitive healing is achievable, whereas type 1 tumors are best treated by endoscopic removal and long-term follow-up.
From the Department of Surgery, Division of General Surgery (Drs Schindl and Niederle), and the Institute of Clinical Pathology (Dr Kaserer), University of Vienna, Austria.
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