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Examining Rectal Carcinoids in the Era of Screening Colonoscopy: A Surveillance, Epidemiology, and End Results Analysis

Taghavi, Sharven M.D., M.P.H.1; Jayarajan, Senthil N. M.D.1; Powers, Benjamin D. M.D.1; Davey, Adam Ph.D.2; Willis, Alliric I. M.D.1

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e318291f512
Original Contributions: Colorectal/Anal Neoplasia
Abstract

BACKGROUND: Little is known about the epidemiology of rectal carcinoids in the United States since the implementation of screening colonoscopy.

OBJECTIVE: The goal of this study was to identify epidemiological differences between rectal and small intestinal carcinoids.

DESIGN: This study was retrospective in design.

SETTING: Surveillance, Epidemiology and End Results registry data from 1992 to 2008 were examined.

PATIENTS: Patients with rectal carcinoids included those with carcinoid tumors of the rectum. Patients with small intestinal carcinoids included those with carcinoids in the duodenum, jejunum, or ileum.

MAIN OUTCOME MEASURE: Epidemiological characteristics of rectal carcinoids were identified and compared with small intestinal carcinoids using multiple variable logistic regression.

RESULTS: Patients with rectal carcinoids were more likely to be women (OR, 1.196 (95% CI, 1.090–1.311); p < 0.001). Rectal carcinoids were more common among all minorities, including Asians (OR, 10.063 (95% CI, 8.330–12.157); p < 0.001), blacks (OR, 1.994 (95% CI, 1.770–2.246); p < 0.001), and Hispanics (OR, 2.682 (95% CI, 2.291–3.141), p < 0.001). Patients in the 50- to 59-year age group (OR, 0.752 (95% CI, 0.599–0.944); p = 0.014) were more likely to be diagnosed with rectal carcinoids than those in the 60- to 69-year (OR, 0.481 (95% CI, 0.383–0.605); p < 0.001) and ≥70-year age groups (OR, 0.220 (95% CI, 0.175–0.277); p < 0.001). Rectal carcinoids were more likely to be diagnosed in the screening colonoscopy era among the 50- to 59-year age group (OR, 1.432 (95% CI, 1.082–1.895); p = 0.012). Since the implementation of screening colonoscopy in 2000, the proportion of patients diagnosed with rectal carcinoids has been greater than the proportion diagnosed with small intestinal carcinoids in every year except 2001, and the proportion of patients diagnosed with rectal carcinoids after 2000 has been greater than the proportion diagnosed with small intestinal carcinoids in 12 of 13 Surveillance, Epidemiology, and End Results registry reporting agencies.

CONCLUSIONS: Rectal carcinoids and small intestinal carcinoids are epidemiologically distinct tumors with unique presentations. In the era of screening colonoscopy, rectal carcinoids are the more common tumor.

Author Information

1 Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania

2 Department of Public Health, Temple University, Philadelphia, Pennsylvania

Financial Disclosure: None reported.

Funding/Support: Adam Davey, Ph.D., is supported by grants from the National Institutes of Health (R01CA158361, R21CA158877, and R01HD069769) and the US Department of Agriculture (PENR-2010–04643 and PENR-2011–04489).

Poster presentation at the Gastrointestinal Cancers Symposium of the American Society of Clinical Oncology, San Francisco, CA, January 19 to 21, 2012, and the 65th Annual Cancer Symposium of the Society of Surgical Oncology, Orlando, FL, March 21 to 24, 2012.

Correspondence: Alliric I. Willis, M.D., 3401 N Broad St, Department of Surgery, Zone C, Suite 400, Philadelphia, PA 19140. E-mail: Alliric.Willis@tuhs.temple.edu

© 2013 The American Society of Colon and Rectal Surgeons