Appendiceal Neuroendocrine, Goblet and Signet-Ring Cell Tumors: A Spectrum of Diseases with Different Patterns of Presentation and Outcome.
PURPOSE
Appendiceal tumors are a heterogeneous group of diseases that include typical neuroendocrine tumors (TNET), goblet cell carcinoids (GCC), and atypical GCC. Atypical GCC are classified into signet-ring cell cancers (SRCC) and poorly differentiated appendiceal adenocarcinoids. The prognosis and management of these diseases is unclear because there are no prospective studies. The aim of this study is to assess the characteristics and outcome of appendiceal TNET, GCC, and SRCC patients.


MATERIALS AND METHODS
Appendiceal TNET, GCC, and SRCC patients diagnosed between 1973 and 2011 were identified in the Surveillance Epidemiology and End Results (SEER) database. Demographics, type of surgery, and clinicopathologic characteristics were collected. Survival functions were estimated by the Kaplan-Meier method, and log-rank test was used to assess the difference in overall survival (OS) among the three histologies.


RESULTS
The SEER database yielded 1,021 TNET patients, 1,582 with GCC, and 534 SRCC patients. TNET presented at a younger age (p < 0.001). Patients with SRCC presented with advanced stage disease (p < 0.001). The median OS (mOS) for GCC and TNET patients was not reached; mOS for SRCC was 24 months. Multivariate analysis stratified for stage revealed significantly longer survival for TNET and GCC than SRCC (p < 0.001).


CONCLUSION
This is the largest report to date for appendiceal neuroendocrine tumor patients, suggesting a spectrum of diseases with different characteristics and outcomes. In this report, we present a treatment approach for this complex spectrum of disease, based on the experience of Ohio State and Emory Universities investigators.
['Shaib|Walid|W|', 'Krishna|Kavya|K|', 'Kim|Sungjin|S|', 'Goodman|Michael|M|', 'Rock|Jonathan|J|', 'Chen|Zhengjia|Z|', 'Brutcher|Edith|E|', 'Staley|Charles Iii|CI|', 'Maithel|Shishir K|SK|', 'Abdel-Missih|Samih|S|', 'El-Rayes|Bassel F|BF|', 'Bekaii-Saab|Tanios|T|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001063:Appendiceal Neoplasms D002276:Carcinoid Tumor D018279:Carcinoma, Signet Ring Cell D002648:Child D016208:Databases, Factual D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D018358:Neuroendocrine Tumors D011379:Prognosis D012189:Retrospective Studies D015996:Survival Rate D016896:Treatment Outcome D055815:Young Adult
Neuroendocrine tumors Goblet cells Survival Appendiceal neoplasms Disease management Signet ring