Carcinoid of the Rectum Risk Stratification (CaRRs): A Strategy for Preoperative Outcome Assessment |
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Authors: | Bridget N Fahy Laura H Tang David Klimstra W Douglas Wong Jose G Guillem Philip B Paty Larissa K F Temple Jinru Shia Martin R Weiser |
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Institution: | (1) Department of Surgery, Division of Colorectal Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA;(2) Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA |
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Abstract: | Background Predicting rectal carcinoid behavior based exclusively on tumor size is imprecise. We sought to identify factors associated
with outcome and incorporate them into a pre-operative risk stratification scheme.
Methods Seventy rectal carcinoid patients evaluated at our institution were identified. Demographic, clinical, and histopathologic
data were collected and correlated with recurrence and survival.
Results The mean age of our cohort was 53.6 years. Fifty-seven percent of patients were female. The mean tumor size was 1.3 cm (range:
0.1–5 cm). Twenty-five percent of patients had deeply invasive tumors (into the muscularis propria or deeper); an equal percentage
had tumors with lymphovascular invasion (LVI) or an elevated mitotic rate (≥2/50 HPF). Eleven patients (17%) had distant metastases
at presentation. Sixty-one patients were followed for a median of 22 months (2–308 months), during which seven patients developed
recurrence and seven died of disease (2/7 who developed recurrence). Poor outcome was associated with large tumor size, deep
invasion, presence of LVI, and elevated mitotic rate. These factors were incorporated into a carcinoid of the rectum risk
stratification (CaRRS) score. CaRRS predicted recurrence-free and disease-specific survival better than any single factor
alone.
Conclusions Poor prognostic features of rectal carcinoids include: large size, deep invasion, LVI, and elevated mitotic rate. The CaRRS
score incorporates these features and accurately predicts outcome. Because the CaRRS score is based upon values available
on pre-operative biopsy, it can identify patients with very favorable prognosis as well as those with poor prognosis that
may benefit from additional staging or surveillance. |
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Keywords: | Carcinoid Rectum Outcome Risk assessment |
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