Department of Internal Medicine, Mount Sinai School of Medicine, 5 East 98th Street, 11th Floor, New York, New York 10029, USA.
Endocr Relat Cancer. 2012 May 24;19(3):381-7. doi: 10.1530/ERC-11-0392. Print 2012 Jun.
Small-intestinal carcinoids (SIC) are the most common small-bowel malignancies. We sought to determine the risk of developing SIC before and after other primary malignancies (PM) and the prognosis of patients with SIC, with and without another PM. We used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with SICs between 1973 and 2007. Multiple primary-standardized incidence ratios were calculated as an approximation of relative risk (RR) to explore the association of SICs with metachronous malignancies. Survival analysis was performed using Kaplan-Meier methods and Cox proportional-hazard models. Among 8331 patients with SICs, 2424 (29%) had another PM at some time. The most common sites were prostate (26.2%), breast (14.3%), colon (9.1%), lung/bronchus (6.3%), and bladder (5.3%). Overall, 67% of patients had a PM diagnosed before SIC (pre-SIC), 33% after SIC (post-SIC), and 8% had a PM both before and after SIC. Among the pre-SIC group, the risk of future SIC was increased after cancers of the small bowel (RR 11.86 (95% CI: 6.13-20.72)), esophagus (4.05 (1.10-10.36)), colon (1.39 (1.05-1.81)), kidney (1.93 (1.12-3.09)), prostate (1.38 (1.17-1.62)), and leukemia (2.15 (1.18-3.61)). Among the post-SIC group, there was an increased risk of future PM of the small bowel (8.78 (4.54-15.34)), liver (2.49 (1.08-4.91)), prostate (1.25 (1.0-1.53)), and thyroid (2.73 (1.10-5.62)). Compared to patients with only SIC, those with a PM pre-SIC had worse mean survival (57.9 vs 40.9 months, HR 1.55 (1.42-1.69), P<0.001). In conclusion, almost one-third of patients with SICs have an associated metachronous primary tumor. When these primaries occur prior to (but not after) the SIC diagnosis, the prognosis is worse than with an initial SIC. The type of malignancies associated with SICs may guide future screening efforts.
小肠类癌（SIC）是最常见的小肠恶性肿瘤。我们旨在确定 SIC 与其他原发性恶性肿瘤（PM）发生之前和之后的风险，以及是否存在另一种 PM 对 SIC 患者的预后的影响。我们使用监测、流行病学和最终结果数据库，确定了 1973 年至 2007 年期间诊断为 SIC 患者。通过计算多个原发性标准化发病率比来近似相对风险（RR），以探索 SIC 与同时发生的恶性肿瘤之间的关联。采用 Kaplan-Meier 方法和 Cox 比例风险模型进行生存分析。在 8331 名 SIC 患者中，2424 名（29%）在某个时间点患有另一种 PM。最常见的部位是前列腺（26.2%）、乳房（14.3%）、结肠（9.1%）、肺/支气管（6.3%）和膀胱（5.3%）。总体而言，67%的患者在 SIC 之前（前 SIC）诊断出 PM，33%在 SIC 之后（后 SIC），8%在 SIC 前后均有 PM。在前 SIC 组中，SIC 后发生小肠癌（RR 11.86（95%CI：6.13-20.72））、食管癌（4.05（1.10-10.36））、结肠癌（1.39（1.05-1.81））、肾癌（1.93（1.12-3.09））、前列腺癌（1.38（1.17-1.62））和白血病（2.15（1.18-3.61））的风险增加。在后 SIC 组中，SIC 后发生小肠癌（8.78（4.54-15.34））、肝癌（2.49（1.08-4.91））、前列腺癌（1.25（1.0-1.53））和甲状腺癌（2.73（1.10-5.62））的风险增加。与仅患有 SIC 的患者相比，那些在 SIC 前患有 PM 的患者的平均生存时间更差（57.9 与 40.9 个月，HR 1.55（1.42-1.69），P<0.001）。总之，几乎三分之一的 SIC 患者有相关的同时发生的原发性肿瘤。当这些原发性肿瘤发生在 SIC 诊断之前（而不是之后）时，预后比初次 SIC 更差。与 SIC 相关的恶性肿瘤类型可能指导未来的筛查工作。
