Proposed staging system for gastrointestinal carcinoid tumors

Gastrointestinal carcinoid tumors are rare neuroendocrine tumors with no staging system in existence. The goal of this study was to establish a staging system consistent with the American Joint Commission on Cancer Staging Systems using the TNM strategy. A retrospective review of our prospective database of 990 hepatopancreaticobiliary patients and our tumor registry identified 108 patients with gastrointestinal carcinoid tumors from June 1990 to September 2006. Tumors were classified into our staging system by depth of penetration, size of primary tumor, nodal status, and the presence/absence of distant metastasis. Patients were staged as Stage 1, 22 per cent; Stage II, 29 per cent; Stage 3, 12 per cent; and Stage 4, 35 per cent. There were 41 men and 57 women with a median age of 58.5 years (range, 19-86 years). Primary tumors included 52 small bowel, 12 colon, 19 rectum, nine stomach, and seven of unknown primary origin. The use of our initial staging system demonstrated a trend in differences in survival across all four stages. The use of our initial staging proposal delineates the biology of the disease with accurate overall survival estimates. The addition of a dedicated American Joint Commission on Cancer staging system is needed for gastrointestinal carcinoids. Widespread use of this staging system may contribute to the future management and treatment of gastrointestinal carcinoid tumors.