Carcinoid tumors: Analysis of prognostic factors and survival in 301 patients from a referral center

Background: Little is known about factors related to prognosis in patients with carcinoid disease. In this study we have tried to identify such factors. Patients and methods: We have evaluated 301 consecutive carcinoid patients (256 midgut, 39 foregut and six hindgut) referred during 15 years for medical treatment with respect to tumor distribution, hormone production, prognostic factors and survival. Results: Survival was significantly shorter in midgut carcinoid patients with greater than or equal to 5 liver metastases or with high levels of urinary 5-hydroxyindoleacetic acid, plasma chromogranin A or neuropeptide K. By univariate analysis, these variables together with the presence of carcinoid syndrome were related to a higher risk of dying. In multivariate analyses, performed in the 71 patients with full information on all variables, advanced age and plasma chromogranin A > 5000 mu g/l were independent predictors of overall survival. Conclusions: Poor prognostic factors for midgut carcinoid patients were multiple liver metastases, presence of carcinoid syndrome and high levels of the tumor markers studied. In this study the only independent predictors of bad prognosis in midgut carcinoid patients were advanced age, which however is inherently related to overall survival, and plasma chromogranin A > 5000 mu g/l. Thus, chromogranin A may prove to be an important prognostic marker for patients with carcinoid tumors.