[Clinicopathological features and prognosis of different gastric carcinoid subtypes]

Abstract

Objective: To analyze the clinicopathological features and their relation to treatment and prognosis in different gastric carcinoid subtypes.

Methods: The data of surgically treated 39 patients with gastric carcinoids (9 of type I and 30 of type III) were retrospectively analyzed. Univariate and multivariate analysis were performed using Chi square test (chi(2)) and Cox model, respectively. The survival rates were analyzed by Kaplan-Meier method, and the factors affecting survival by Log rank test.

Results: Of the 9 patients with type I carcinoids, 5 underwent endoscopic or surgical resection, and extra antrectomy was performed in 2 patients simultaneously. 3 cases had a proximal gastrectomy, and 1 underwent total gastrectomy. Among the 30 patients with type III gastric carcinoids, 21 underwent radical resection, 6 had a palliative resection, and the remaining 3 underwent exploration and biopsy only due to invasion into adjacent organs and distant metastasis. Infiltration beyond the submucosa was found in all 30 type III gastric carcinoid patients, but in only 1 of 9 patients with type I gastric carcinoids. Regional lymph node metastases were found in 27 of 30 type III carcinoid cases, but in none of type I. Distant metastases occurred in 5 patients of type III carcinoid (4 in the liver and 1 in the ovary). There were statistically significant differences between type I and type III carcinoids in the sex, tumor number, location, size and infiltration depth of the tumors, the regional lymph node metastasis, distant metastasis and lymphatic emboli (P < 0.05 in all). The overall 5-year survival rate was 49.7% for the whole group, and 100.0% and 37.2% for type I and type III carcinoids, respectively. Univariate analysis revealed that the number of tumor, tumor size (> 2 cm), serosal invasion, regional lymph node metastasis and distant metastasis were all significant factors affecting the survival (P < 0.05 in all). However, by multivariate analysis, only distant metastasis was found to be a significant prognostic predictor.

Conclusion: The prognosis of type III carcinoids is much poorer than that of type I. Subtyping of gastric carcinoids is helpful in guiding clinical management, and also in prediction of malignant potential and prognosis.