Small bowel carcinoid: Location isn’t everything!

Table 1 American Joint Committee on Cancer staging for small bowel carcinoid

Stage	TNM	Size or depth of invasion	Lymph node status	Distant metastases
0	TisN0M0	Carcinoma in-situ; tumor size < 0.5 mm	None	None
I	T1N0M0	Invasion into the lamina propria or submucosa; tumor size 1 cm or less	None	None
IIA	T2N0M0	Invasion into the lamina propria and/or submucosa and tumor size > 1 cm	None	None
		Invasion into the muscularis propria	None	None
IIB	T3N0M0	Invasion into the submucosa	None	None
IIIA	T4N0M0	Invasion into the serosa/visceral peritoneum or into nearby organ or structures	None	None
IIIB	T1-4N1M0	Any	Positive regional lymph nodes	None
IV	T1-4N0-1M1	Any	Any	Yes

Source: Ref[9,35], with permission.

Table 2 Patient demographics based primary tumor site (n = 3763)

	Duodenum	Jejunum	Ileum	Total
	(n = 872)	(n = 324)	(n = 2567)	(n = 3763)
Age
≤ 40	4.10%	6.80%	5.20%	5.10%
41-50	12.60%	11.40%	14.30%	13.60%
51-60	24.00%	24.70%	28.20%	26.90%
61-70	28.40%	27.80%	25.90%	26.70%
> 70	30.80%	29.30%	26.30%	27.60%
Gender
Female	46.00%	43.20%	50.80%	49.00%
Male	54.00%	56.80%	49.20%	51.00%
Race
White	67.90%	82.40%	88.40%	83.20%
Black	23.30%	15.70%	9.30%	13.10%
Asian/other	8.80%	1.90%	2.30%	3.70%
Geographic region
East	38.90%	32.70%	34.20%	35.10%
Northern plains	14.90%	14.20%	15.80%	15.50%
Pacific coast	39.70%	44.40%	42.90%	42.30%
Southwest	6.50%	8.60%	7.10%	7.10%
Year of diagnosis
1988-1992	4.40%	9.60%	8.10%	7.30%
1993-1997	7.10%	10.50%	12.50%	11.10%
1998-2003	30.30%	31.80%	29.80%	30.10%
2004-2009	58.30%	48.10%	49.60%	51.50%
Number of primaries
1	88.40%	90.70%	87.60%	88.00%
2+	11.60%	9.30%	12.40%	12.00%
Extent of surgery
Local excision	62.20%	4.30%	3.20%	17.00%
Resection	35.30%	88.60%	88.00%	75.80%
Debulking	2.50%	7.10%	8.80%	7.20%
Number of lymph nodes examined
0	81%	35%	20%	36%
1-6	13%	34%	29%	26%
7-12	4%	19%	23%	18%
13+	3%	11%	28%	20%
Tumor size (cm)
0.1-1.0	42%	20%	20%	25%
1.1-2.0	15%	41%	35%	31%
2.1+	9%	24%	31%	25%
Unknown	34%	14%	14%	18%
T-stage
T1	60%	8%	12%	23%
T2	10%	12%	14%	13%
T3	3%	42%	39%	31%
T4	5%	32%	29%	24%
TNOS	21%	6%	6%	10%
N-stage
N0	12%	13%	16%	15%
N1	7%	52%	64%	49%
Unknown	81%	35%	20%	36%
M-stage
M0	97%	75%	74%	79%
M1	3%	25%	26%	21%
TNM-stage
I	6%	1%	4%	4%
IIA	2%	1%	3%	2%
IIB	1%	5%	4%	3%
IIIA	1%	2%	2%	1%
IIIB	5%	37%	45%	35%
IV	3%	25%	26%	21%
Unknown	83%	30%	16%	33%

Table 3 Multivariable regression analysis based on 10-year disease-specific survival

Parameters	Reference	Comparison	HR	1P vaule
Primary site	Duodenum	Jejunum	1.020 (0.616-1.690)	0.752
		Ileum	0.956 (0.612-1.493)	0.966
Age	≤ 40	41-50	1.628 (0.775-3.420)	0.198
		51-60	2.491 (1.254-4.949)	0.009
		61-70	3.643 (1.849-7.178)	< 0.001
		> 70	6.777 (3.456-13.292)	< 0.001
Gender	Male	Female	1.028 (0.855-1.237)	0.767
Race	Caucasian	Black	1.320 (0.968-1.799)	0.079
		Asian/other	1.243 (0.671-2.305)	0.489
Number of primaries	1	2+	0.401 (0.284-0.564)	< 0.001
Extent of surgery	Resection	Local excision	0.721 (0.404-1.287)	0.269
		Debulking	1.067 (0.809-1.407)	0.647
Number of lymph nodes examined	13+	0	1.621 (1.063-2.445)	0.025
		1-6	1.673 (1.245-2.248)	< 0.001
		7-12	1.525 (1.114-2.087)	0.008
T-stage	T1	T2	1.741 (0.939-3.227)	0.079
		T3	3.205 (1.895-5.422)	< 0.001
		T4	4.793 (2.809-8.178)	< 0.001
		TNOS	1.486 (0.787-2.807)	0.222
N-stage	N0	N1	1.856 (1.010-3.411)	0.438
		Unknown	1.527 (08.10-2.880)	-
M-stage	M0	M1	2.744 (2.175-3.461)	< 0.001

¹Log-rank test.