Survival and prognostic factors in patients with small bowel carcinoid tumour

Background: Previous studies of small bowel carcinoid tumours usually presented overall or relative survival. This study, in addition, evaluated disease-specific survival in a cohort of patients in a geographically defined population. Methods: Patients diagnosed with carcinoid of the jejunum or ileum in Jonkoping County between 1960 and 2005 were eligible for inclusion. Available tumour specimens were re-examined to confirm the diagnosis. Medical records and pathology reports were reviewed in detail. Results: A total of 145 patients were included in the study. One hundred and thirty-five patients underwent surgery in connection with the diagnosis. Resection was considered complete (R0) in 74 patients (54.8 per cent). Only two localized tumours recurred, whereas no patient with distant metastases was cured. Patients with regional metastases who underwent R0 resection had a better survival than patients with incomplete resection (P = 0.005), and a majority of patients remained recurrence-free. Median overall survival was 7.2 years and median disease-specific survival 12.3 years. In multivariable analysis, age 61-74 years (hazard ratio (HR) 3.78, 95 per cent confidence interval 1.86 to 7.68), age 75 years or more (HR 3.96, 1.79 to 8.74), distant metastases (HR 14.44, 1.59 to 131.36) and incomplete tumour resection (HR 2.71, 1.11 to 6.61) were associated with worse disease-specific survival. Later time period of diagnosis (HR 0.45, 0.24 to 0.84) was associated with better disease-specific survival. Conclusion: Age, disease stage and complete resection were identified as independent prognostic factors for survival in patients with small bowel carcinoid tumours. The importance of achieving R0 resection is therefore emphasized.