Foregut carcinoids: A clinical and biochemical analysis

Background. Gastrointestinal foregut carcinoids make up a small percentage (3% to 6%) of all reported carcinoids. Because these tumors are so uncommon , comparisons between the subtypes have been difficult. The goal of this st udy was to compare the hormonal and clinical characteristics of gastric, du odenal, and pancreatic carcinoids. Methods. A prospective database of approximately 750 carcinoid patients see n by one author over 25 years was reviewed, and the 104 patients with gastr ic (33), duodenal (17), or pancreatic (54) carcinoids were selected as the subgroup for analysis. These patients were compared with regard to hormone levels, clinical course, treatment, and survival. Results. Duodenal carcinoids exhibited significantly lower serotoninergic h ormone levels than did the gastric and pancreatic carcinoids (urine 5-hydro xyindoleacetic acid [mg/24 h], 5 +/- 1 vs 16 +/- 5 and 47 +/- 12, respectiv ely, P = .03). Pancreatic carcinoids presented with more advanced stage (di stant metastases 87% vs 42% and 20% for gastric and duodenal, respectively) and had worse outcomes than patients with gastric and duodenal tumors with 10-year survivals of 10%, 59%, and 58%, respectively (P = .003). Conclusions. Pancreatic carcinoids produce higher levels of serotoninergic hormones and have a significantly higher stage and worse outcome than other foregut carcinoids. This study demonstrates that the organ of origin is an important determinant of hormonal activity and clinical course for patient s with foregut carcinoids.