Changing Therapy for Gastrinoma

OBJECTIVE The author analyzed potential survival determinants in gastrinoma to characterize a possible uniform staging system and to determine whether complete surgical resection improves expected survival. SUMMARY AND BACKGROUND DATA Gastrinoma is an indolent yet malignant neuroendocrine tumor. The associated gastric acid hypersecretion can be controlled medically. Staging of gastrinoma is inconsistent and the role of surgical resection controversial. METHODS Seventy-four patients with gastrinoma with a minimum 5-year follow-up were assessed. Cox's proportional hazards regression model was used to examine the association of risk factors with survival. RESULTS The following factors had no effect on survival: age at diagnosis, sex, presence of lymph node metastases, associated multiple endocrine neoplasia, and method of ulcer treatment. The three unique determinants of survival were primary tumor size (relative risk, 1.534; p = 0.0005), liver metastases (relative risk, 2.947; p = 0.0209), and complete surgical resection (relative risk, 0.163; p = 0.0076). On the basis of these risk factors, a uniform staging system is proposed and predictive survival curves developed. CONCLUSIONS The primary determinants of survival in gastrinoma are the size of the primary tumor and liver metastases. Complete surgical resection reduces mortality, regardless of other factors.