Gastroenterology

Gastroenterology

Volume 132, Issue 3, March 2007, Pages 899-904
Gastroenterology

Clinical–alimentary tract
Survival From Malignant Digestive Endocrine Tumors in England and Wales: A Population-Based Study

https://doi.org/10.1053/j.gastro.2007.01.006Get rights and content

Background & Aims: Little is known about the prognosis of patients with malignant digestive endocrine tumors (MDETs), primarily because of their rarity. Methods: Survival from these tumors has been evaluated in a large, well-defined, national population. All patients diagnosed and registered in England and Wales during the 14-year period from 1986 to 1999 were followed up for vital status to the end of 2001. Relative survival was estimated and the impact of age, sex, period, histology, and anatomic site modeled. Results: Among 4104 cases of MDETs, 21.2% were small cell tumors. Relative survival for all MDETs combined was 45.9% at 5 years and 38.4% at 10 years. Five-year survival was 56.8% for well-differentiated tumors but only 5.2% for small cell tumors (P < .0001). Survival was highest for large bowel tumors and lowest for esophageal tumors. Among well-differentiated pancreatic tumors, 5-year relative survival was 49.2% for insulinomas, 39.9% for gastrinomas, 17.1% for glucagonomas, 26.3% for carcinoid tumors, and 29.3% for nonfunctioning tumors. There was no difference in survival between socioeconomic groups. Five-year survival did not improve between 1986 and 2001. Survival was higher for women and for younger patients. Gender, age at diagnosis, and anatomic site were independent prognostic factors. Conclusions: The prognosis of patients with MDETs in the general population is considerably worse than is often reported from small hospital case series. Prognosis varies with tumor differentiation, anatomic site, and histologic type. Early diagnosis is difficult; new therapeutic options appear to represent the best approach to improved prognosis.

Section snippets

Materials and Methods

All incident MDETs diagnosed in adults (aged 15–99 years) in the 55 million population of England and Wales during the 14-year period between January 1, 1986, and December 31, 1999, were linked with information from the National Health Service Central Register4 on deaths up to December 31, 2001, by the National Cancer Registry at the Office for National Statistics, and an anonymized extract was provided. Population-based regional cancer registries covering the entire territory of England and

Characteristics of MDETs

The 4104 endocrine carcinomas represented 0.6% of all incident digestive cancers in men during 1986–1999 and 0.7% in women (sex ratio, 0.96). MDETs were grouped into well-differentiated tumors (78.8%) and small cell tumors (21.2%; Table 1). Women were significantly more common among those with small cell tumors (58.8%; P < .001), but the sex ratio was close to unity for well-differentiated tumors. The mean age at diagnosis was 62.8 years (SD, 15.6 years) for patients with well-differentiated

Discussion

This study confirms that MDETs are rare, representing <1% of all malignancies of the digestive tract. The mean age at diagnosis of well-differentiated MDETs (63 years) is lower than for other digestive tract cancers (about 70 years for epithelial tumors). In hospital case series, the mean age at diagnosis is generally lower than in our study, suggesting that the oldest patients with MDETs are rarely seen in specialized centers.16, 17 One of the interests of this population-based study is to

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