BACKGROUND: The clinical significance of lymph-node metastases, multicentric forms, and tumorlets in bronchial carcinoids is still a matter of debate. Aim of this study was to analyze their prevalence and clinical significance in a series of 123 bronchial carcinoids. PATIENTS AND METHODS: Nodal dissection and serial sections of resected lung parenchima for research of multicentric forms and tumorlets were performed in most patients. Survival curve was produced using the Kaplan-Meyer method and multivariate analysis by the Cox proportional hazard model. RESULTS: Lymph-node involvement was present in 14% of typical (14 of 100) and 13.04% of atypical carcinoids (3 of 23). Multicentric forms (syncronous carcinoids or tumorlets) were found in 11.3% of the total with a negative impact on survival (p = 0.021). Multiple tumorlets were found in 7.3% of all cases at the standard pathologic examination, but whenever accurate palpation and serial sections of the surgical specimen were performed, the percentage reached 24% of the cases. Overall survival was 98.2%, 95.8%, and 83.9% for typical and 71.6%, 57.3%, and 24% for atypical carcinoid respectively at 5, 10, and 15 years. Time from surgery was significantly directly correlated with recurrences (p < 0.0001) and disease related death (p = 0.0002). CONCLUSIONS: A high prevalence of tumorlets, multiple carcinoids, and lymph-nodal involvement was found in our series. On the basis of these observations bronchial carcinoids always require major surgical procedures with systematic nodal dissection, and a careful search for multifocal lesions should always be performed. Follow-up should always be accurate and protracted, due to the frequency of very long-term relapses (often more than 10 years after surgery).
BACKGROUND: The clinical significance of lymph-node metastases, multicentric forms, and tumorlets in bronchial carcinoids is still a matter of debate. Aim of this study was to analyze their prevalence and clinical significance in a series of 123 bronchial carcinoids. PATIENTS AND METHODS: Nodal dissection and serial sections of resected lung parenchima for research of multicentric forms and tumorlets were performed in most patients. Survival curve was produced using the Kaplan-Meyer method and multivariate analysis by the Cox proportional hazard model. RESULTS: Lymph-node involvement was present in 14% of typical (14 of 100) and 13.04% of atypical carcinoids (3 of 23). Multicentric forms (syncronous carcinoids or tumorlets) were found in 11.3% of the total with a negative impact on survival (p = 0.021). Multiple tumorlets were found in 7.3% of all cases at the standard pathologic examination, but whenever accurate palpation and serial sections of the surgical specimen were performed, the percentage reached 24% of the cases. Overall survival was 98.2%, 95.8%, and 83.9% for typical and 71.6%, 57.3%, and 24% for atypical carcinoid respectively at 5, 10, and 15 years. Time from surgery was significantly directly correlated with recurrences (p < 0.0001) and disease related death (p = 0.0002). CONCLUSIONS: A high prevalence of tumorlets, multiple carcinoids, and lymph-nodal involvement was found in our series. On the basis of these observations bronchial carcinoids always require major surgical procedures with systematic nodal dissection, and a careful search for multifocal lesions should always be performed. Follow-up should always be accurate and protracted, due to the frequency of very long-term relapses (often more than 10 years after surgery).
Authors: A Faggiano; P Ferolla; F Grimaldi; D Campana; M Manzoni; M V Davì; A Bianchi; R Valcavi; E Papini; D Giuffrida; D Ferone; G Fanciulli; G Arnaldi; G M Franchi; G Francia; G Fasola; L Crinò; A Pontecorvi; P Tomassetti; A Colao Journal: J Endocrinol Invest Date: 2011-11-09 Impact factor: 4.256
Authors: Robert A Ramirez; Aman Chauhan; Juan Gimenez; Katharine E H Thomas; Ioni Kokodis; Brianne A Voros Journal: Rev Endocr Metab Disord Date: 2017-12 Impact factor: 6.514
Authors: John K Ramage; A Ahmed; J Ardill; N Bax; D J Breen; M E Caplin; P Corrie; J Davar; A H Davies; V Lewington; T Meyer; J Newell-Price; G Poston; N Reed; A Rockall; W Steward; R V Thakker; C Toubanakis; J Valle; C Verbeke; A B Grossman Journal: Gut Date: 2011-11-03 Impact factor: 23.059
Authors: Daniel Kaemmerer; Christiane Reimann; Elisa Specht; Ralph M Wirtz; Manal Sayeg; Richard P Baum; Stefan Schulz; Amelie Lupp Journal: Oncotarget Date: 2015-02-20