Maria Cattoni1, Eric Vallières1, Lisa M Brown2, Amir A Sarkeshik2, Stefano Margaritora3, Alessandra Siciliani3, Pier Luigi Filosso4, Francesco Guerrera4, Andrea Imperatori5, Nicola Rotolo5, Farhood Farjah6, Grace Wandell6, Kimberly Costas7, Catherine Mann1, Michal Hubka8, Stephen Kaplan8, Alexander S Farivar1, Ralph W Aye1, Brian E Louie9. 1. Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Wash. 2. Section of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, Calif. 3. Unit of Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy. 4. Department of Thoracic Surgery, San Giovanni Battista Hospital, Torino, Italy. 5. Center of Thoracic Surgery, Department of Surgical and Morphological Sciences, University of Insubria, Ospedale di Circolo, Varese, Italy. 6. Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Wash. 7. Division of Thoracic Surgery, Providence Regional Medical Center, Everett, Wash. 8. Division of Thoracic Surgery, Virginia Mason Hospital & Seattle Medical Center, Seattle, Wash. 9. Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Wash. Electronic address: brian.louie@swedish.org.
Abstract
OBJECTIVE: Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors. METHODS: We retrospectively analyzed 510 consecutive patients (female/male, 313/197; median age, 61 years; interquartile range, 51-70) undergoing lung resection for a primary neuroendocrine tumor between 2000 and 2015 in 8 centers. Multivariable analysis was performed using a Cox proportional hazard model to identify factors associated with disease-specific survival. A new staging system was proposed on the basis of the results of this analysis. Kaplan-Meier disease-specific survival was analyzed by stage using the proposed and the 7th TNM staging system. RESULTS: Follow-up was completed in 490 of 510 patients at a median of 51 months (interquartile range, 18-99). Histology (G1-typical carcinoid vs G2-atypical carcinoid vs G3-large-cell neuroendocrine carcinoma) and pT were independently associated with survival, but pN was not. After regrouping histology and pT, we proposed the following staging system: IA (pT1-2G1), IB (pT3G1, pT1G2), IIA (pT4G1, pT2-3G2, pT1G3), IIB (pT4G2, pT2-3G3), and III (pT4G3). The 5-year survivals were 97.9%, 81.0%, 69.1%, 51.8%, and 0%, respectively. By using the 7th TNM, 5-year survivals were 95.0%, 92.3%, 67.7%, 70.9%, and 65.1% for stage IA, IB, IIA, IIB, and III, respectively. CONCLUSIONS: Incorporating histology and regrouping tumor stage create a unique neuroendocrine tumor staging system that seems to predict survival better than the 7th TNM classification.
OBJECTIVE:Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors. METHODS: We retrospectively analyzed 510 consecutive patients (female/male, 313/197; median age, 61 years; interquartile range, 51-70) undergoing lung resection for a primary neuroendocrine tumor between 2000 and 2015 in 8 centers. Multivariable analysis was performed using a Cox proportional hazard model to identify factors associated with disease-specific survival. A new staging system was proposed on the basis of the results of this analysis. Kaplan-Meier disease-specific survival was analyzed by stage using the proposed and the 7th TNM staging system. RESULTS: Follow-up was completed in 490 of 510 patients at a median of 51 months (interquartile range, 18-99). Histology (G1-typical carcinoid vs G2-atypical carcinoid vs G3-large-cell neuroendocrine carcinoma) and pT were independently associated with survival, but pN was not. After regrouping histology and pT, we proposed the following staging system: IA (pT1-2G1), IB (pT3G1, pT1G2), IIA (pT4G1, pT2-3G2, pT1G3), IIB (pT4G2, pT2-3G3), and III (pT4G3). The 5-year survivals were 97.9%, 81.0%, 69.1%, 51.8%, and 0%, respectively. By using the 7th TNM, 5-year survivals were 95.0%, 92.3%, 67.7%, 70.9%, and 65.1% for stage IA, IB, IIA, IIB, and III, respectively. CONCLUSIONS: Incorporating histology and regrouping tumor stage create a unique neuroendocrine tumor staging system that seems to predict survival better than the 7th TNM classification.
Authors: José-María Matilla; M Zabaleta; E Martínez-Téllez; J Abal; A Rodríguez-Fuster; J Hernández-Hernández Journal: J Clin Transl Res Date: 2020-09-02
Authors: Philippe Thuillier; Virginia Liberini; Osvaldo Rampado; Elena Gallio; Bruno De Santi; Francesco Ceci; Jasna Metovic; Mauro Papotti; Marco Volante; Filippo Molinari; Désirée Deandreis Journal: Biomedicines Date: 2021-03-10