Modlin I M, Sandor A
Gastric Surgical Pathobiology Research Group, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA.
Cancer. 1997 Feb 15;79(4):813-29. doi: 10.1002/(sici)1097-0142(19970215)79:4<813::aid-cncr19>3.0.co;2-2.
Carcinoid tumors are unusual and most reports are anecdotal or limited in number. A series of 2837 cases was published in 1975. No recent large series is available.
The authors evaluated 5468 cases identified by the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) from 1973 to 1991 together with 2837 carcinoid cases previously registered by 2 earlier NCI programs. To the authors' knowledge, the 8305 carcinoid tumors analyzed represent the largest current epidemiology series to date.
The most frequent sites for carcinoids were the gastrointestinal (GI) tract (73.7%) and the bronchopulmonary system (25.1%). Within the GI tract, most occurred in the small bowel (28.7%), appendix (18.9%), and rectum (12.6%). For all sites, age-adjusted incidence rates were highest in African American males (2.12 per 100,000 population per year). Associated noncarcinoid tumors were frequent in conjunction with small intestinal (16.6%), appendiceal (14.6%), and colonic carcinoids (13.1%). The highest percentage of nonlocalized lesions were noted for pancreatic (76.1%), colonic (71.2%), and small intestinal carcinoids (70.7%) and this corresponded to their poor 5-year survival rates (34.1%, 41.6%, and 55.4%, respectively). The best 5-year survival rates were recorded for appendiceal (85.9%), bronchopulmonary (76.6%), and rectal carcinoids (72.2%). These exhibited invasive growth or metastatic spread in only 35.4%, 27.2%, and 14.2% of cases, respectively.
Carcinoids appear to have increased in incidence in the past 20 years. In part, this may be due to different surgical rules of the various registries, improved diagnostic technology, and increased awareness. A cumulative analysis of all types of carcinoid tumors in the SEER group indicates that in 45.3% metastases are already evident at the time of diagnosis. The overall 5-year survival rate of all carcinoid tumors regardless of site was 50.4% +/- 6.4%.
类癌肿瘤较为罕见，多数报道为个案或数量有限。1975年发表了一系列2837例的病例报道。目前尚无近期的大型病例系列报道。
作者评估了美国国立癌症研究所（NCI）监测、流行病学和最终结果（SEER）项目在1973年至1991年期间识别出的5468例病例，以及NCI之前两个项目先前登记的2837例类癌病例。据作者所知，所分析的这8305例类癌肿瘤是目前最大的流行病学病例系列。
类癌最常见的部位是胃肠道（73.7%）和支气管肺系统（25.1%）。在胃肠道内，大多数发生在小肠（28.7%）、阑尾（18.9%）和直肠（12.6%）。在所有部位中，年龄调整发病率在非裔美国男性中最高（每年每10万人中2.12例）。与小肠类癌（16.6%）、阑尾类癌（14.6%）和结肠类癌（13.1%）同时发生相关非类癌肿瘤很常见。胰腺类癌（76.1%）、结肠类癌（71.2%）和小肠类癌（70.7%）的非局限性病变比例最高，这与它们较差的5年生存率相对应（分别为34.1%、41.6%和55.4%）。阑尾类癌（85.9%）、支气管肺类癌（76.6%）和直肠类癌（72.2%）的5年生存率最佳。这些病例分别仅有35.4%、27.2%和14.2%表现出侵袭性生长或转移扩散。
在过去20年中，类癌的发病率似乎有所上升。部分原因可能是各登记处不同的手术规则、诊断技术的改进以及意识的提高。对SEER组中所有类型类癌肿瘤的累积分析表明，45.3%的病例在诊断时已有转移迹象。无论部位如何，所有类癌肿瘤的总体5年生存率为50.4%±6.4%。
