Abstract
Background
Pulmonary carcinoids are being staged along the lines of lung cancer American Joint Committee on Cancer (AJCC) staging system. The current study evaluated the prognostic value of a modified staging system for patients with pulmonary carcinoid.
Patients and methods
Surveillance, Epidemiology and End Results (SEER) database (2004–2014) was searched through SEER*Stat program. Through recursive partitioning analysis and subsequent decision tree formation, suggested stages were constructed. Overall survival analyses were performed through Kaplan–Meier analysis. The cancer-specific Cox regression hazard (adjusted for age, gender, race, sub-site and surgery) was calculated and pairwise comparisons of hazard ratios were conducted.
Results
A total of 6395 pulmonary carcinoid patients were recruited in the period from 2004–2014. Pairwise hazard ratio comparisons among different AJCC 8th stages were conducted and all comparisons were non-significant except for stage IIB vs. stage IIIA and stage IIIA vs. stage IIIB. Pairwise hazard ratio comparisons among different modified staging system stages were conducted and all comparisons were significant except for stage III vs. stage IV. C-statistic (using death from pulmonary carcinoid as the dependent variable) for AJCC 8th staging system was: 0.794 (SE 0.013; 95% CI 0.769–0.818); for AJCC 7th staging system was: 0.789 (SE 0.013; 95% CI 0.764–0.815), while c-statistic for the modified staging system was: 0.802 (SE 0.012; 95% CI 0.778–0.827).
Conclusion
The proposed modified staging system provided a simpler yet prognostically more relevant classification of pulmonary carcinoids compared to AJCC staging systems (both 7th and 8th editions).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Quaedvlieg PF, Visser O, Lamers CB, Janssen-Heijen ML, Taal BG. Epidemiology and survival in patients with carcinoid disease in The Netherlands. An epidemiological study with 2391 patients. Ann Oncol. 2001;12(9):1295–300.
Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97(4):934–59.
Abdel-Rahman O. Vascular endothelial growth factor (VEGF) pathway and neuroendocrine neoplasms (NENs): prognostic and therapeutic considerations. Tumor Biol. 2014;35(11):10615–25.
Hemminki K, Li X. Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden. Cancer. 2001;92(8):2204–10.
Travis WD, Giroux DJ, Chansky K, Crowley J, Asamura H, Brambilla E, et al. The IASLC Lung Cancer Staging Project: proposals for the inclusion of broncho-pulmonary carcinoid tumors in the forthcoming (seventh) edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2008;3(11):1213–23.
Abdel-Rahman O. Validation of the prognostic value of new sub-stages within the AJCC 8th edition of non-small cell lung cancer. Clin Transl Oncol. 2017. doi:10.1007/s12094-017-1673-7.
Abdel-Rahman O. Validation of the AJCC 8th lung cancer staging system among patients with small cell lung cancer. Clin Transl Oncol. 2017. doi:10.1007/s12094-017-1739-6.
Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063–72.
Lococo F, Stefani A, Treglia G. Is fludeoxyglucose-fluorodeoxyglucose-positron emission tomography/computed tomography ((18)F-FDG-PET/CT) really useless in staging pulmonary carcinoid tumors and in discriminating histological subtypes? Controversial points and future perspectives. Ann Thorac Med. 2015;10(3):217–8.
Eberhardt WE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A 3rd, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2015;10(11):1515–22.
Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9.
Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 18 Regs Custom Data (with additional treatment fields), Nov 2016 Sub (1973–2014 varying)—Linked To County Attributes—Total US, 1969–2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission. https://seer.cancer.gov/
Abdel-Rahman O. Assessment of the prognostic and discriminating value of the novel bioscore system for breast cancer; a SEER database analysis. Breast Cancer Res Treat. 2017. doi:10.1007/s10549-017-4244-2.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was not funded.
Conflict of interest
The author declares that he has no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by the author.
Informed consent
As this study is based on a publicly available database without identifying patient information, informed consent was not needed.
Rights and permissions
About this article
Cite this article
Abdel-Rahman, O. Modified staging system for pulmonary carcinoids on the basis of lung cancer TNM system. Clin Transl Oncol 20, 670–677 (2018). https://doi.org/10.1007/s12094-017-1759-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12094-017-1759-2