Clinical Investigation Of Biological Behavior And Surgical Treatment Of Digestive System Carcinoid

Objective: Digestive system carcinoids are very rare diseases in clinicswithout specific symptoms, but they have good prognosis with earlyappropriate treatments. We will discuss the diagnosis, treatment, and prognosisof digestive system carcinoid through97cases that are collected fromin-patients. This study has significant contribution to the future clinicaltreatment of digestive system carcinoid as well as its acknowledgement andearly detection.Methods: Sample cases were collected from patients who werehospitalized in Hebei Medical University4th hospital during the period fromAugust2001to May2011.97cases were included in this study to carry outretrospective analysis. General characteristics and digestive systemcarcinoid-related factors were collected and recorded for each patient: age, sex,time period to be hospitalized, family history of cancer, anamnesis andassociated medical history (results of endoscopy, blood test, CT, abdominal B–ultrasound et al), analysis of postoperative pathological results (generalmicroscopic examination, immunohistochemistry condition and the depth oftumor invasion, tumor diameter, lymph node metastasis rate). Hospital courseof digestive system carcinoid, included surgical treatment: surgery type,operation option, resection site, the way of reconstructing digestive tract,endoscopic treatment et al, on-going treatment of digestive tract carcinoid(detailed chemotherapy, period cycle et al), and follow-up. With all theseavailable clinical materials and data, we carried out statistical analysis usingSPSS13.0software. The rates between different groups were represented bychi-square tests and the analysis of survival was carried out by Life-Tablesmethod.Results: First, among all these cases,63cases received in-hospital surgical treatment,34cases received endoscope removal. Second, this studyshowed wide-distribution in age and it had patients from18yr to82yr. Third,among all these97cases, rectum carcinoid occurs most frequently and it has49cases in total. Two cases accompanied with hepatic metastasis. The nextfrequently occurred is gastric carcinoid which had38cases identified. Thereare four cases of duodedum, four cases of colon and two cases of appendix aswell as three cases for bile duct and liver, one case of esophagus, respectively.Forth, all clinical symptoms don't display any specificity while dominated bybellyache, diarrhea, hemorrhage of digestive tract, abdominal distension. Fifth,among all these cases of97,83cases were diagnosed as carcinoid beforesurgery,9cases were misdiagnosed as adenocarcinoma,3carcinoids of liverand bile duct,2cases of appendix carcinoid without certain diagnosis beforesurgery. Sixth, the invasion depth of carcinoid is significantly correlated withthe metastasis and its size:63cases were received surgery and21cases havedistant and lymphatic metastasis. The relationship between the invasion depthand the metastasis: the ratio between the whole layer invasion and the invasionof mucous layer or beyond is significant as well as the ratio between the wholelayer invasion and the invasion of muscle layer (P<0.05). The diameter ofcarcinoid is related with the metastasis: the ratio between the tumor withdiameter greater than2cm and the tumor with diameter less or equal than2cmbut greater than1cm as well as the ratio between the tumor with diametergreater than2cm and the tumor with diameter less or equal than1cm aresignificant (P<0.05). Seventh, follow-ups among these97cases, one case withgastric carcinoid died of respiratory and circulatory failure,2cases were lostin touch with, and others were under follow-ups during the period from1month to11years.22cases died because of the recurrence,72cases survivedand no recurrence was detected. Suspicious lumps no found at local or systemby CT scan. Local mucosal is completely by endoscopic review and norecurrence. The one-year, three-year, and five-year survival rate of all patientswere98.88%,89.35%,69.68%respectively.Conclusions: 1Digestive system carcinoid is a rare disease in middle-age people, andthere are no marked proportion differences between male and female digestivecarcinoid patients. Tumor location and proportion: the proportion of rectalcarcinoid is47.42%; the proportion of gastric carcinoid is38.14%; theproportion of duodenal carcinoid is4.12%; the proportion of colon carcinoidis4.12%and seldom seen in other location.2Digestive system carcinoids don't display any symptom specificity.Rectal carcinoids are dominated by bellyache and hemorrhage of digestivetract. But, gastric carcinoids are dominated by bellyache and abdominaldistension.3The serum tumor marker test demonstrated that the increase ratio ofCA19-9, AFP, CA50and iron protein was33.33%,22.22%,18.75%and16.66%respectively. The increases of other tumor markers were rarely seen.CT, abdominal type B ultrasonic test helps to locate tumors and to determinewhether they have metastasis, which is very important for the generalestimation of patients' condition as well as for patients' treatment design.4Endoscopic tests served as a major way for the detection of digestivesystem carcinoids. But, pathological tests of living tissues serve as a goldenway for its diagnosis. Some patients will be misdiagnosed as adenocarcinoma.However, Immunohistochemical staining can be a supplementary way forcertain diagnosis if regular pathological tests can't say it for sure.5The rate of tumor invasion to the mucous and submucous layer, musclelayer, serosa, the tissue of perienteric, and lymph metastasis is6.25%(1/16),25%(5/20),62.50%(15/24) respectively. All these ratios are statisticallysignificant. These results indicate that the rate of lymph metastasis ispositively correlated with the depth of tumor invasion. The rate of lymphmetastasis is7.14%(1/14),18.18%(4/22),59.26%(16/27) respectively in thegroup with the tumor's diameter equal or less than1cm, in the group with thetumor's diameter which is greater than1cm but equal or less than2cm, and inthe group with the tumor's diameter greater than2cm. The ratio between thetumor with diameter greater than2cm and the tumor with diameter less or equal than2cm but greater than1cm as well as the ratio between the tumorwith diameter greater than2cm and the tumor with diameter less or equal than1cm are statistically significant. These results indicate that the rate of lymphmetastasis increase with the increase of the tumor diameter.6Patients of gastric carcinoids and rectal carcinoids with tumors that arerestricted in mucous layer or submucous layer without any metastasis arereceived endoscopic surgery removal or extended local excision. This seemsto have high success rate as well as high survival rate without any recurrence.Patients of digestive tract carcinoids with tumors that extended to the musclelayer or submucous layer can't do endoscopic tumor removal. However, acomprehensive test should be done and a special surgery should be designedbased on patients' general condition. They can't give up any surgical treatmenteven if there is metastasis.7The prognosis of digestive system carcinoids is very good. All patientswith this disease should receive early treatment. The survival rate of one-year,three-year, and five-year is98.88%,89.35%,69.68%respectively.