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Carcinoid Tumors of the Gastrointestinal Tract in Minority Patients
Susana C Wishnia1, David B McAneny1, Antonio de las Morenas2, Jennifer E Rosen1
1Boston University School of Medicine, Department of Surgery, Boston, MA;2Boston University School of Medicine, Department of Pathology, Boston, MA
Objective: To analyze patients with carcinoid tumors to assess differences between Caucasian and Minority patients.
Design: Case series.
Setting: Academic medical center.
Patients: All patients with primary gastrointestinal carcinoid tumors treated at our institution, a primary referral center, between 1999 and 2006.
Interventions: none.
Main Outcome Measures: Tumor size, depth of mural penetration, metastases, treatment, recurrence, and survival.
Results: Fifty-two patients (23 women and 29 men) had confirmed gastrointestinal tract carcinoids. Mean age at diagnosis was 56 years (range, 20-82 years). Patients were classified as either Caucasian (22) or Minority (25 Black; 4 Hispanic; and 1 Lebanese). Two patients had MEN-1 syndrome and three patients had multifocal tumors. Median tumor size was 10mm (range, 1-40mm). Treatment included endoscopic resection (24), local excision (2), bowel resection (22), gastrectomy (3), and biopsy alone (1). Four tumors locally recurred after endoscopic polypectomies. Two of these patients underwent curative right hemicolectomies; and two patients have residual carcinoid, despite subsequent endoscopic resections.
Depth of mural invasion was determined for 28 patients, of whom 12 (43%) were limited to the mucosa or submucosa. Minorities were 8.5 times more likely to have disease limited to the mucosa or sub-mucosa, compared to Caucasian patients (OR=0.120, 95% CI, 0.02 to 0.7). In addition, Minorities were more likely to have foregut and hindgut tumors than mid-gut tumors (p<0.05). Race did not impact tumor size, lymph node involvement, or survival.
Conclusions: Tumor location and depth of invasion significantly differ between Caucasian and Minorities in our patient population. Among Caucasians, tumors were more likely to penetrate the muscularis and to involve the mid-gut. Further investigation is warranted to analyze these findings and to understand their implications.
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