%0 Journal Article
%T Factors Associated with Survival of Veterans with Gastrointestinal Neuroendocrine Tumors
%A Bryan L. Balmadrid
%A Catherine M. Thomas
%A Cynthia J. Coffman
%A Rodger A. Liddle
%A Deborah A. Fisher
%J Journal of Cancer Epidemiology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/986708
%X Background. Gastrointestinal (GI) neuroendocrine tumor (NET) incidence has been increasing; however, GI NET within the national Veterans Affairs (VA) health system has not been described. Methods. We used the VA Central Cancer Registry to identify the cohort of patients diagnosed with GI NET in 1995每2009. Cox regression models were constructed to explore factors associated with survival. Results. We included 1793 patients with NET of the stomach (9%), duodenum (10%), small intestine (24%), colon (19%) or rectum (38%). Twenty percent were diagnosed in 1995每1999, 35% in 2000每2004, and 45% in 2005每2009. Unadjusted 5-year survival rates were: stomach 56%, duodenum 66%, small intestine 52%, colon 67%, and rectum 84%. Factors associated with shorter survival were increasing age, hazard ratio (HR) 1.05 (95% CI 1.04每1.06), NET location [compared to rectum: stomach HR 2.26 (95% CI 1.68每3.05), duodenum HR 1.70 (95% CI 1.26每2.28), small intestine HR 1.85 (95% CI 1.42每2.42), and colon 1.83 (95% CI 1.41每2.39)], stage [compared to in situ/local: regional HR 1.15 (95% CI 0.90每1.47), distant HR 2.38 (95% CI 1.87每3.05)], and earlier period of diagnosis [compared to 1995每1999: 2000每2004 HR 0.70 (95% CI 0.59每0.85), 2005每2009 HR 0.43 (95% CI 0.34每0.54)]. Conclusions. The incidence of GI NET has also increased over time in the VA system with similar survival rates to those observed in non-VA settings. Worsened survival was associated with older age, tumor site, advanced stage, and earlier year of diagnosis. 1. Introduction Neuroendocrine tumors (NETs) arise from the embryologic neuroendocrine system and thus can occur in any location in the body. The gastrointestinal (GI) tract and lungs are the most common primary tumor sites. Based on Surveillance Epidemiology and End Results (SEER) data, NET incidence has increased 300%, up to 5.3 per 100,000, in the last three decades [1]. International data also suggest similar increases, as more recent studies have observed higher incidences than previous studies [2每4]. NET prevalence has also increased to 103,312 in the US population making it more prevalent than adenocarcinoma of the stomach and pancreas combined [1, 5]. Much of the apparent rise in new diagnoses may reflect incidental detection of NET through the increased use of imaging modalities such as computed tomography (CT) scans and endoscopic procedures for other indications rather than a true increase in tumor incidence. NETs are relatively slow growing tumors usually diagnosed late in the clinical course. Retrospective analysis suggests an average delay of nine years
%U http://www.hindawi.com/journals/jce/2012/986708/