Peng Song1, Ruochuan Zang1, Lei Liu1, Xiayimaier Dan1, Shugeng Gao1. 1. Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Abstract
BACKGROUND: Pulmonary atypical carcinoid (AC) tumors are rare malignant neoplasms and controversy exists regarding management and prognosis. The purpose of this retrospective study was to describe characteristics, and outcomes of patients treated for pulmonary AC tumors. METHODS: All patients with a diagnosis of primary pulmonary AC tumor treated from 1999 to 2013 were reviewed. Data collected included demographics, tobacco use, clinical presentation, tumor size and location, pathological stage, immunohistochemical expression, lymph node status, treatment, and survival. RESULTS: There were 55 men and 13 women with a mean age of 55 years. Symptoms were present in 47 patients (69.1%). Twenty-eight patients (41.2%) had a centrally located tumor and 40 patients (58.8%) presented with peripheral tumor localization. Operations included 49 lobectomies, 10 pneumonectomies, 6 bilobectomies, 2 sleeve lobectomies, and 1 wedge resection. There were no peri-operative mortalities. There were 22 patients in stage I, 27 in stage II, 19 in stage III. Twenty-nine (42.6%) patients died and twenty (29.4%) patients relapsed during the follow-up period. The 5- and 10-year survival rates for the 68 cases were 70.6% and 61.8%, respectively. Relapse-free survival was significantly worsened by increasing Ki-67 index (P<0.01) and lymph-nodes involvement (P=0.02). Multivariate Cox regression indicated that nodal status was significantly associated with survival (P=0.038). CONCLUSIONS: Lymph-nodes involvement is the major adverse prognostic factor in AC. Recurrence is more common among patients with high Ki-67 level. The use of adjuvant chemotherapy postoperatively in patients with pathologically lymphnode-positive and pathologically lymphnode-negative disease seems to have no survival advantage.
BACKGROUND: Pulmonary atypical carcinoid (AC) tumors are rare malignant neoplasms and controversy exists regarding management and prognosis. The purpose of this retrospective study was to describe characteristics, and outcomes of patients treated for pulmonary AC tumors. METHODS: All patients with a diagnosis of primary pulmonary AC tumor treated from 1999 to 2013 were reviewed. Data collected included demographics, tobacco use, clinical presentation, tumor size and location, pathological stage, immunohistochemical expression, lymph node status, treatment, and survival. RESULTS: There were 55 men and 13 women with a mean age of 55 years. Symptoms were present in 47 patients (69.1%). Twenty-eight patients (41.2%) had a centrally located tumor and 40 patients (58.8%) presented with peripheral tumor localization. Operations included 49 lobectomies, 10 pneumonectomies, 6 bilobectomies, 2 sleeve lobectomies, and 1 wedge resection. There were no peri-operative mortalities. There were 22 patients in stage I, 27 in stage II, 19 in stage III. Twenty-nine (42.6%) patients died and twenty (29.4%) patients relapsed during the follow-up period. The 5- and 10-year survival rates for the 68 cases were 70.6% and 61.8%, respectively. Relapse-free survival was significantly worsened by increasing Ki-67 index (P<0.01) and lymph-nodes involvement (P=0.02). Multivariate Cox regression indicated that nodal status was significantly associated with survival (P=0.038). CONCLUSIONS: Lymph-nodes involvement is the major adverse prognostic factor in AC. Recurrence is more common among patients with high Ki-67 level. The use of adjuvant chemotherapy postoperatively in patients with pathologically lymphnode-positive and pathologically lymphnode-negative disease seems to have no survival advantage.
Entities:
Keywords:
Carcinoid tumor; prognosis; pulmonary; surgery
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