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Management and Disease Outcome of Type I Gastric Neuroendocrine Tumors: The Mount Sinai Experience

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Abstract

Background and Aim

The incidence of gastric neuroendocrine tumors (NETs) has increased tenfold since the 1970s. Our aim was to describe the clinicopathologic profile, management, and outcomes of type I gastric NETs at The Mount Sinai Hospital.

Methods

From existing databases of the Mount Sinai Division of Gastrointestinal Pathology and the Carcinoid Cancer Foundation, we identified 56 patients with type I gastric NETs seen at The Mount Sinai Hospital from 1993 to 2012. We generated a comprehensive dataset encompassing demographic, clinical, endoscopic, and pathologic factors. Survival information was determined from medical records and the Social Security Death Index. Tumor–node–metastasis staging was conducted, and tumors were graded based on mitotic counts and Ki67 index.

Results

Median NET size was 3.0 mm; 55.8 % displayed multifocal disease. Stages I, II, III, and IV disease were observed in 83.8, 10.8, 5.4, and 0 %, respectively. Tumors were either low (69.7 %) or intermediate (30.3 %) grade. Furthermore, 3.6 % of patients developed gastric dysplasia, and 5.5 % had gastric adenocarcinoma. Patients underwent endoscopy every 15 months, while 28.6 % underwent polypectomy, 32.7 % somatostatin therapy, and 46.4 % surgical resection. 5- and 10-year disease-specific survival was 100 %.

Conclusions

Most patients received annual endoscopic surveillance, with a minority undergoing surgical resection, though outcomes remained excellent independent of therapeutic approach. We identified a very low but real rate of loco-regional spread, despite the generally indolent behavior of type I gastric NETs. Several patients demonstrated concurrent dysplasia or adenocarcinoma, underscoring the efficacy of regular endoscopic management not only for gastric NETs, but also for dysplasia and adenocarcinoma.

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Abbreviations

AJCC:

American Joint Committee on Cancer

Anti-IF:

Intrinsic factor antibody

Anti-PC:

Parietal cell antibody

ECL:

Enterochromaffin-like

EGD:

Esophagogastroduodenoscopy

ENETS:

European Neuroendocrine Tumor Society

EUS:

Endoscopic ultrasound

GEP-NET:

Gastroenteropancreatic neuroendocrine tumor

MALT:

Mucosa-associated lymphoid tissue

NET:

Neuroendocrine tumor

PPI:

Proton-pump inhibitor

TNM:

Tumor–node–metastasis

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Acknowledgments

We are grateful to National Center for Advancing Translational Sciences (NCATS) KL2TR000069.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    William C. Chen, Richard R. P. Warner, Noam Harpaz, Steven H. Itzkowitz & Michelle K. Kim

  2. Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Celia M. Divino

  3. Division of Gastrointestinal Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Stephen C. Ward & Noam Harpaz

  4. 50 East 98th Street, Apt 8A, New York, NY, 10029, USA

    William C. Chen

  5. 5 East 98th Street, 11th Floor, New York, NY, 10029, USA

    Richard R. P. Warner

  6. Annenberg Building 15th Floor, Room 92, 1468 Madison Avenue, New York, NY, 10029, USA

    Stephen C. Ward

  7. Annenberg Building 15th Floor, Room 38, 1468 Madison Avenue, New York, NY, 10029, USA

    Noam Harpaz

  8. 5 East 98th Street, 14th Floor, Suite A, New York, NY, 10029, USA

    Celia M. Divino

  9. One Gustave L. Levy Place, Box 1069, New York, NY, 10029, USA

    Steven H. Itzkowitz & Michelle K. Kim

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  1. William C. Chen
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Correspondence to Michelle K. Kim.

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Chen, W.C., Warner, R.R.P., Ward, S.C. et al. Management and Disease Outcome of Type I Gastric Neuroendocrine Tumors: The Mount Sinai Experience. Dig Dis Sci 60, 996–1003 (2015). https://doi.org/10.1007/s10620-014-3410-1

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  • DOI: https://doi.org/10.1007/s10620-014-3410-1

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