Pier Luigi Filosso1, Francesco Guerrera2, Andrea Evangelista3, Stefan Welter4, Pascal Thomas5, Paula Moreno Casado6, Erino Angelo Rendina7, Federico Venuta7, Luca Ampollini8, Alessandro Brunelli9, Franco Stella10, Mario Nosotti11, Federico Raveglia12, Valentina Larocca13, Ottavio Rena14, Stefano Margaritora15, Francesco Ardissone16, William D Travis17, Inderpal Sarkaria18, Dariusz Sagan19. 1. Department of Thoracic Surgery, University of Torino, Torino, Italy pierluigi.filosso@unito.it. 2. Department of Thoracic Surgery, University of Torino, Torino, Italy. 3. Unit of Cancer Epidemiology and CPO Piedmont, S. Giovanni Battista Hospital, Torino, Italy. 4. Division of Thoracic Surgery, Ruhrlandklinik, Essen, Germany. 5. Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, Aix-Marseille University and Hospitals System of Marseille (AP-HM), Marseille, France. 6. Department of Thoracic Surgery, University Hospital 'Reina Sofia', Cordoba, Spain. 7. Fondazione Eleonora Lorillard Spencer Cenci, Sapienza University of Rome, Rome, Italy. 8. Unit of Thoracic Surgery, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy. 9. Department of Thoracic Surgery, St James's University Hospital, Leeds, UK. 10. Unit of Thoracic Surgery, Policlinico S. Orsola-Malpighi, Bologna, Italy. 11. Unit of Thoracic Surgery, Ospedale Maggiore Policlinico, University of Milano, Milan, Italy. 12. Unit of Thoracic Surgery, Azienda Ospedaliera S. Paolo, Milan, Italy. 13. Unit of Thoracic Surgery, Ospedale 'Spirito Santo' Azienda ASL di Pescara, Pescara, Italy. 14. Unit of Thoracic Surgery, 'Amedeo Avogadro' University of Eastern Piedmont, Novara, Italy. 15. Unit of Thoracic Surgery, Catholic University 'Sacred Heart', Rome, Italy. 16. Unit of Thoracic Surgery, Azienda Ospedaliero-Universitaria 'San Luigi' Orbassano, University of Torino, Torino, Italy. 17. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 18. Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 19. Department of Thoracic Surgery, Medical University of Lublin, Lublin, Poland.
Abstract
OBJECTIVES: Typical carcinoids (TCs) are uncommon, slow-growing neoplasms, usually with high 5-year survival rates. As these are rare tumours, their management is still based on small clinical observations and no international guidelines exist. Based on the European Society of Thoracic Surgeon Neuroendocrine Tumours Working Group (NET-WG) Database, we evaluated factors that may influence TCs mortality. METHODS: Using the NET-WG database, an analysis on TC survival was performed. Overall survival (OS) was calculated starting from the date of intervention. Predictors of OS were investigated using the Cox model with shared frailty (accounting for the within-centre correlation). Candidate predictors were: gender, age, smoking habit, tumour location, previous malignancy, Eastern Cooperative Oncology Group (ECOG) performance status (PS), pT, pN, TNM stage and tumour vascular invasion. The final model included predictors with P ≤ 0.15 after a backward selection. Missing data in the evaluated predictors were multiple-imputed and combined estimates were obtained from five imputed data sets. RESULTS: For 58 of 1167 TC patients vital status was unavailable and analyses were therefore performed on 1109 patients from 17 institutions worldwide. During a median follow-up of 50 months, 87 patients died, with a 5-year OS rate of 93.7% (95% confidence interval: 91.7-95.3). Backward selection resulted in a prediction model for mortality containing age, gender, previous malignancies, peripheral tumour, TNM stage and ECOG PS. The final model showed a good discrimination ability with a C-statistic equal to 0.836 (bootstrap optimism-corrected 0.806). CONCLUSIONS: We presented and validated a promising prognostic model for TC survival, showing good calibration and discrimination ability. Further analyses are needed and could be focused on an external validation of this model.
OBJECTIVES: Typical carcinoids (TCs) are uncommon, slow-growing neoplasms, usually with high 5-year survival rates. As these are rare tumours, their management is still based on small clinical observations and no international guidelines exist. Based on the European Society of Thoracic Surgeon Neuroendocrine Tumours Working Group (NET-WG) Database, we evaluated factors that may influence TCs mortality. METHODS: Using the NET-WG database, an analysis on TC survival was performed. Overall survival (OS) was calculated starting from the date of intervention. Predictors of OS were investigated using the Cox model with shared frailty (accounting for the within-centre correlation). Candidate predictors were: gender, age, smoking habit, tumour location, previous malignancy, Eastern Cooperative Oncology Group (ECOG) performance status (PS), pT, pN, TNM stage and tumour vascular invasion. The final model included predictors with P ≤ 0.15 after a backward selection. Missing data in the evaluated predictors were multiple-imputed and combined estimates were obtained from five imputed data sets. RESULTS: For 58 of 1167 TC patients vital status was unavailable and analyses were therefore performed on 1109 patients from 17 institutions worldwide. During a median follow-up of 50 months, 87 patients died, with a 5-year OS rate of 93.7% (95% confidence interval: 91.7-95.3). Backward selection resulted in a prediction model for mortality containing age, gender, previous malignancies, peripheral tumour, TNM stage and ECOG PS. The final model showed a good discrimination ability with a C-statistic equal to 0.836 (bootstrap optimism-corrected 0.806). CONCLUSIONS: We presented and validated a promising prognostic model for TC survival, showing good calibration and discrimination ability. Further analyses are needed and could be focused on an external validation of this model.
Authors: Michael S Kent; Sumithra J Mandrekar; Rodney Landreneau; Francis Nichols; Nathan R Foster; Thomas A DiPetrillo; Bryan Meyers; Dwight E Heron; David R Jones; Angelina D Tan; Sandra Starnes; Joe B Putnam; Hiran C Fernando Journal: Ann Thorac Surg Date: 2016-04-19 Impact factor: 4.330
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