David T. Beyer

Neuroendocrine Tumors of the Jejunum and Ileum

AJCC Cancer Staging Manual, 8th Edition Copyright 2016 American Joint Committee on Cancer. All rights reserved. Version 1 | Page 1 of 2 Authors Eugene A. Woltering, Emily K. Bergsland, David T. Beyer, Thomas M. O’Dorisio, Guido Rindi, David S. Klimstra, Laura H. Tang, Diane Reidy-Lagunes, Jonathan R. Strosberg, Edward M. Wolin, Aaron I. Vinik, Eric K. Nakakura, Elliot A. Asare, David L. Bushnell, Richard L. Schilsky, Yi-Zarn Wang, Michelle K. Kim, Eric H. Liu, Robert T. Jensen, Rebecca K.S. Wong, John K. Ramage, Kathy Mallin, Rodney F. Pommier

Prognostic Factors in Typical and Atypical Pulmonary Carcinoids

BackgroundnTypical and atypical carcinoids represent approximately 2% of all lung tumors. Survival of patients with typical bronchial carcinoids, unlike the survival of patients with most lung tumors, is generally long but dependent on stage. We report the findings of the Ochsner Medical Center/Louisiana State University (LSU) Health Sciences Center neuroendocrine tumor (NET) program.nnnMethodsnA database with all patients seen at the Ochsner Medical Center/LSU NET program was queried for patients with bronchopulmonary NET. We included patients who had confirmed pathologic bronchopulmonary carcinoid and who had at least 1 clinic visit. Patients with large or small cell NETs or diffuse idiopathic pulmonary neuroendocrine cell hyperplasia were excluded.nnnResultsnA total of 169 patients seen from January 1996 to March 2015 met the inclusion criteria. The mean age at diagnosis was 53 years. Of the tumors, 51% percent (86/169) were well-differentiated, 12% (21/169) were moderately differentiated, and 85% and 53% were positive on positron emission tomography and octreotide scanning, respectively. The 5- and 10-year survival rates were 88% and 81% for well-differentiated tumors and 80% and 42% for moderately differentiated tumors, respectively. The 10-year survival rates stratified by Ki-67 index ranges 0-2%, >2%-10%, and >10% were 90%, 72%, and 44%, respectively (P<0.05).nnnConclusionnOverall, patients with bronchial carcinoids have long 5- and 10-year survival rates. We found significant survival differences between nodal status, differentiation status, and carcinoid phenotype. Interestingly, the difference in survival stratified by Ki-67 indices was statistically significant despite its absence in the World Health Organization grading system. As with gastroenteropancreatic NETs, Ki-67 index could become a valuable prognostic indicator for bronchial carcinoids.

Neuroendocrine Tumors of the Colon and Rectum

Risk Assessment Models The AJCC recently established guidelines that will be used to evaluate published statistical prediction models for the purpose of granting endorsement for clinical use. Although this is a monumental step toward the goal of precision medicine, this work was published only very recently. For this reason, the existing models that have been published or may be in clinical use have not yet been evaluated for this cancer site by the Precision Medicine Core of the AJCC. In the future, the statistical prediction models for this cancer site will be evaluated, and those that meet all AJCC criteria will be endorsed.

Neuroendocrine Tumors of the Stomach

AJCC Cancer Staging Manual, 8th Edition Copyright 2016 American Joint Committee on Cancer. All rights reserved. Version 1 | Page 1 of 2 Authors Eugene A. Woltering, Emily K. Bergsland, David T. Beyer, Thomas M. ODorisio, Guido Rindi, David S. Klimstra, Laura H. Tang, Diane Reidy-Lagunes, Jonathan R. Strosberg, Edward M. Wolin, Aaron I. Vinik, Eric K. Nakakura, Elliot A. Asare, David L. Bushnell, Richard L. Schilsky, Yi-Zarn Wang, Michelle K. Kim, Eric H. Liu, Robert T. Jensen, Rebecca K.S. Wong, John K. Ramage, Rodney F. Pommier

Obturator Canal Lymph Node Metastasis from Rectal Carcinoid Tumors: Total Mesorectal Excision May Be Insufficient

BackgroundOptimal surgical treatment for small early rectal carcinoids is controversial. Large tumors (greater than 2xa0cm) and those with imaging evidence of lymph node metastasis are generally treated by low anterior resection (LAR) with total mesorectal excision (TME). We first observed and reported that midgut carcinoid with extensive mesenteric lymphadenopathy often develops alternated lymphatic drainage pathways. We hypothesize that rectal carcinoids have the same potential to develop alternated lymphatic pathways outside the mesorectal envelope, which allows tumor deposits to be missed by traditional TME.MethodsTwenty-two consecutive rectal carcinoid surgical patient charts were reviewed to determine if alternated lymphatic drainage occurred and resulted in extra-mesorectal metastasis. We attempted to identify any risk factor(s) that may lead to developing such alternated lymphatic drainage pathways.ResultsThirteen patients underwent initial LAR with TME (13/22, 59xa0%) and nine underwent a staged debulking for locoregional residual disease or regional/distant metastasis after previous resection (9/22, 41xa0%). Fourteen (14/22, 64xa0%) underwent radio-guided surgery in attempt to achieve a higher level of pelvic/distant metastatic disease detection and debulking. Six patients (6/22, 27xa0%) had obturator canal lymph node metastases confirmed histologically.ConclusionsBased on our study, at least 27xa0% of rectal carcinoid patients may have extra-mesorectal metastasis that would be missed by the traditional TME. Radio-guided surgery can identify and remove such metastasis. The effect of having such extra-mesorectal metastasis and its surgical removal on long-term survival has yet to be determined.