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Journal of Cancer Epidemiology
Volume 2012, Article ID 986708, 5 pages
Clinical Study

Factors Associated with Survival of Veterans with Gastrointestinal Neuroendocrine Tumors

1Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
2Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, USA
3Division of Gastroenterology, East Carolina University, Greenville, NC 27834, USA
4Epidemiologic Research and Information Center, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
5Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
6Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA

Received 29 February 2012; Accepted 21 March 2012

Academic Editor: Lynnette Ferguson

Copyright © 2012 Bryan L. Balmadrid et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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 1995–2009. 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 1995–1999, 35% in 2000–2004, and 45% in 2005–2009. 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 1.04–1.06), NET location [compared to rectum: stomach HR 2.26 (95% CI 1.68–3.05), duodenum HR 1.70 (95% CI 1.26–2.28), small intestine HR 1.85 (95% CI 1.42–2.42), and colon 1.83 (95% CI 1.41–2.39)], stage [compared to in situ/local: regional HR 1.15 (95% CI 0.90–1.47), distant HR 2.38 (95% CI 1.87–3.05)], and earlier period of diagnosis [compared to 1995–1999: 2000–2004 HR 0.70 (95% CI 0.59–0.85), 2005–2009 HR 0.43 (95% CI 0.34–0.54)]. 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.