Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Clinical Characteristics of Gastrointestinal Carcinoid Tumors

단일 센터에서 경험한 위장관 유암종의 임상 특성

  • Lee, Myoung-Hee (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Shin, Sung-Jae (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Jeon, Su-Jin (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Lim, Sun-Gyo (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Lee, Yoon-Chul (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Hwang, Jae-Chul (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Lee, Kee-Myung (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Lee, Kwang-Jae (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Kim, Jin-Hong (Department of Gastroenterology, Ajou University School of Medicine)
  • 이명희 (아주대학교 의과대학 소화기내과학교실) ;
  • 신성재 (아주대학교 의과대학 소화기내과학교실) ;
  • 전수진 (아주대학교 의과대학 소화기내과학교실) ;
  • 임선교 (아주대학교 의과대학 소화기내과학교실) ;
  • 이윤철 (아주대학교 의과대학 소화기내과학교실) ;
  • 황재철 (아주대학교 의과대학 소화기내과학교실) ;
  • 이기명 (아주대학교 의과대학 소화기내과학교실) ;
  • 이광재 (아주대학교 의과대학 소화기내과학교실) ;
  • 김진홍 (아주대학교 의과대학 소화기내과학교실)
  • Received : 2009.12.07
  • Accepted : 2010.05.30
  • Published : 2010.06.30
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Abstract

Background/Aims: Various factors have been reported that can predict the clinical course and outcome of patients with gastrointestinal (GI) carcinoid tumors. We analyzed the clinical characteristics of GI carcinoid tumors and the factors associated with metastasis. Methods: We retrospectively analyzed the clinical manifestations, treatment modalities and prognosis of 83 patients with GI carcinoid tumors. Results: The mean age of the patients was 48 years old. The locations of the carcinoid tumors were rectum (n=60), stomach (n=12), duodenum (n=6), appendix (n=4) and colon (n=1). The most common symptom was non-specific (n=65, 79.5%), and the mean tumor size was 11.2 mm. The main treatment modality was endoscopic resection (n=66, 79.5%). Nine patients showed metastasis, and all of their tumors were larger than 2 cm. Univariate analysis revealed that size, ulceration and invasion of the proper muscle layer were significant factors associated with metastasis. Tumor size (p=0.001) was the only independent factor on multivariate analysis. Conclusions: The diagnosis of small sized, asymptomatic GI carcinoid tumors has increased and endoscopic treatment was a useful modality. Tumor size was a predictive factor for metastasis.

목적: 위장관 유암종은 드물지만 악성의 잠재력이 있어 유암종의 경과 및 예후와 연관된 인자들이 다양하게 보고된다. 이번 연구는 단일 기관에서 경험한 위장관 유암종의 임상 특성을 고찰하고, 전이와 연관된 인자를 분석하고자 하였다. 대상 및 방법: 1994년 12월부터 2008년 9월까지 아주대 병원에서 위장관 유암종으로 진단된 83명의 환자를 대상으로 위 장관 유암종 환자의 특성, 임상 양상, 치료 방법 및 예후를 분석하였다. 결과: 위장관의 부위별 빈도는 직장이 60예로 가장 많았고, 위 12예, 십이지장 6예, 충수돌기 4예, 대장 1예 순이었다. 가장 흔한 증상은 무증상이었으며(n=67, 80.7%) 평균 크기는 11.2 mm였다. 치료는 66예(79.5%)에서 내시경 절제술을 시행하였으며 추적검사에서 잔존 종양은 없었다. 전이는 총 9예로 유암종의 크기가 모두 2 cm 이상이었다. 단변량 분석에서 크기, 궤양의 유무, 고유근층의 침범 여부가 전이를 예측하는 유의한 인자였고 다변량 분석에서 크기만이 독립적인 인자였다(p=0.001). 결론: 최근 무증상의 작은 크기의 위장관 유암종이 발견되는 경우가 증가하여 내시경 접근이 유용한 치료법으로 사용되고 있으며 유암종의 크기는 전이를 예측할 수 있는 독립 인자이다.

Keywords

References

  1. Modlin IM, Oberg K, Chung DC, et al. Gastroenteropancreatic neuroendocrine tumors. Lancet Oncol 2008;9:61-72. https://doi.org/10.1016/S1470-2045(07)70410-2
  2. Rorstad O. Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract. J Surg Oncol 2005;89:151-160. https://doi.org/10.1002/jso.20179
  3. Soga J. Carcinoids and their variant endocrinomas. An analysis of 11842 reported cases. J Exp Clin Cancer Res 2003;22:517-530.
  4. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934-959. https://doi.org/10.1002/cncr.11105
  5. Shebani KO, Souba WW, Finkelstein DM, et al. Prognosis and survival in patients with gastrointestinal tract carcinoid tumors. Ann Surg 1999;229:815-821. https://doi.org/10.1097/00000658-199906000-00008
  6. Koura AN, Giacco GG, Curley SA, Skibber JM, Feig BW, Ellis LM. Carcinoid tumors of the rectum: effect of size, histopathology, and surgical treatment on metastasis free survival. Cancer 1997;79:1294-1298. https://doi.org/10.1002/(SICI)1097-0142(19970401)79:7<1294::AID-CNCR4>3.0.CO;2-H
  7. Soga J. Carcinoids of the rectum: an evaluation of 1271 reported cases. Surg Today 1997;27:112-119. https://doi.org/10.1007/BF02385898
  8. Chang JH, Kim SW, Chung WC, et al. Clinical review of gastrointestinal carcinoid tumor and analysis of the factors predicting metastasis. Korean J Gastroenterol 2007;50:19-25.
  9. Kloppel G, Perren A, Heitz PU. The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification. Ann N Y Acad Sci 2004;1014:13-27. https://doi.org/10.1196/annals.1294.002
  10. Chung MK, Kang DH, Kim ES, et al. Clinical study of gastrointestinal carcinoid tumors. Korean J Gastroenterol 2002;24:135-142.
  11. Ahlman H, Nilsson O. The gut as the largest endocrine organ in the body. Ann Oncol 2001;12(suppl 2):63S-68S. https://doi.org/10.1093/annonc/12.suppl_2.S63
  12. Zeitels J, Naunheim K, Kaplan EL, Straus F 2nd. Carcinoid tumors: a 37-year experience. Arch Surg 1982;117:732-737. https://doi.org/10.1001/archsurg.1982.01380290176031
  13. Thompson GB, van Heerden JA, Martin JK Jr, Schutt AJ, Ilstrup DM, Carney JA. Carcinoid tumors of the gastrointestinal tract: presentation, management, and prognosis. Surgery 1985;98:1054-1063.
  14. Federspiel BH, Burke AP, Sobin LH, Shekitka KM. Rectal and colonic carcinoids. A clinicopathologic study of 84 cases. Cancer 1990;65:135-140. https://doi.org/10.1002/1097-0142(19900101)65:1<135::AID-CNCR2820650127>3.0.CO;2-A
  15. Jetmore AB, Ray JE, Gathright JB Jr, McMullen KM, Hicks TC, Timmcke AE. Rectal carcinoids: the most frequent carcinoid tumor. Dis Colon Rectum 1992;35:717-725. https://doi.org/10.1007/BF02050318
  16. Kim UJ, Lee SK, Cheon JH, et al. Efficacy of endoscopic resection for small rectal carcinoid: a retrospective study. Korean J Gastroenterol 2008;51:174-180.
  17. Oberg K, Astrup L, Eriksson B, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine tumors (including bronchopulmonary and thymic neoplasms). Part II-specific NE tumour types. Acta Oncol 2004;43:626-636. https://doi.org/10.1080/02841860410018584
  18. Maroun J, Kocha W, Kvols L, et al. Guidelines for the diagnosis and management of carcinoid tumours. Part 1: The gastrointestinal tract. A statement from a Canadian national carcinoid expert group. Curr Oncol 2006;13:67-76.
  19. Que FG, Sarmiento JM, Nagorney DM. Hepatic surgery for metastatic gastrointestinal neuroendocrine tumors. Cancer Control 2002;9:67-79. https://doi.org/10.1177/107327480200900111