Curative Surgical Resection as a Component of Multimodality Therapy for Peritoneal Metastases from Goblet Cell Carcinoids

Ann Surg Oncol. 2016 Dec;23(13):4338-4343. doi: 10.1245/s10434-016-5412-z. Epub 2016 Jul 11.


Background: The impact of histopathologic features on oncologic outcomes for patients with peritoneal metastases from goblet cell carcinoid (GCC) undergoing multimodality therapy, including cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC), is unknown.

Methods: This study prospectively analyzed 43 patients with GCC undergoing CRS-HIPEC between 2005 and 2013. Pathology slides were re-reviewed to classify GCC into histologic subtypes according to the Tang classification. Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes.

Results: The 43 patients in this study underwent 50 CRS-HIPEC procedures for peritoneal metastases from GCC, and the majority received neoadjuvant and/or adjuvant systemic chemotherapy. The GCC demonstrated an aggressive phenotype with frequent lymph node and peritoneal metastases without systemic dissemination. The majority of the patients had Tang B GCC. The estimated median overall survival times after surgery for the patients with Tang A, B, and C GCC were respectively 59, 22, and 13 months. In a multivariate Cox-regression analysis, poor survival was associated with patients who had Tang B or C GCC, those undergoing incomplete macroscopic resection, and those with symptoms at the time of CRS-HIPEC. The patients with Tang A GCC demonstrated oncologic outcomes similar to those with intermediate-grade (American Joint Committee on Cancer [AJCC] grade 2) disseminated mucinous appendiceal neoplasms, whereas the patients with Tang B and C GCC demonstrated survival rates similar to or worse than those with high-grade (AJCC grade 3) disseminated mucinous appendiceal neoplasms.

Conclusions: Tang classification is an independent prognostic factor for poor survival after multimodality therapy for GCC. Patients with Tang C GCC demonstrate limited survival and are not ideal candidates for a surgical approach.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Appendiceal Neoplasms / classification
  • Appendiceal Neoplasms / pathology*
  • Carcinoid Tumor / classification
  • Carcinoid Tumor / pathology*
  • Carcinoid Tumor / secondary
  • Carcinoid Tumor / therapy*
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy / methods
  • Cytoreduction Surgical Procedures*
  • Female
  • Goblet Cells
  • Humans
  • Hyperthermia, Induced*
  • Kaplan-Meier Estimate
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Peritoneal Neoplasms / classification
  • Peritoneal Neoplasms / pathology*
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Proportional Hazards Models
  • Retrospective Studies
  • Survival Rate


  • Antineoplastic Agents