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Surgical Resection for Pulmonary Carcinoid: Long-Term Results of Multicentric Study—The Importance of Pathological N Status, More Than We Thought

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Abstract

Background

Histological subdivision into typical (TC) and atypical (AC) is crucial for treatment and prognosis of lung carcinoids but can be also very challenging, even for experts. In this study, we aimed to strengthen or reduce the prognostic value of several pathological, clinical, or per-operative factors some of which are still controversial.

Methods

We retrospectively reviewed clinical records related to 195 patients affected by TC (159) or AC (36) surgically treated between 2000 and 2014, in three different centers. Survival and subtypes comparison analyses were performed to identify potential prognostic factors.

Results

TCs showed a lower rate of nodal involvement than ACs (N0 = 94.9%; N1 = 1.9%; N2 = 3.2% in typical and N0 = 63.8%; N1 = 16.6%; N2 = 19.4% in atypical carcinoids, respectively, p < 0.0001). Long-term oncological results of resected carcinoids were significantly better in TCs than ACs with higher 5- and 10-year overall survival rates (97.2 and 88.2% vs. 77.9 and 68.2%, respectively; p = 0.001) and disease-free survival rates (98.2 and 90.3% in typical and 80.8 and 70.7% atypical carcinoids, respectively; p = 0.001). Risk factors analysis revealed that AC subtype [HR 4.33 (95% CI 1.72–8.03), p = 0.002], pathological nodal involvement [HR 3.05 (95% CI 1.77–5.26), p < 0.0001], and higher SUVmax [HR 4.33 (95% CI 1.03–7.18), p = 0.002] were independently and pejoratively associated with overall survival. Factors associated with a higher risk of recurrence were AC subtype [HR 6.13 (95% CI 1.13–18.86), p = 0.002]; nodal involvement [HR 5.48 (95% CI 2.85–10.51), p < 0.0001]; higher Ki67 expression level [HR 1.09 (95% CI 1.01–1.20), p = 0.047]; and SUVmax [HR 1.83 (95% CI 1.04–3.23), p = 0.035].

Conclusion

Surgery for lung carcinoids allows satisfactory oncological results which mainly depend on carcinoid subtype dichotomy, pathological nodal status, and SUVmax.

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Authors and Affiliations

  1. General Thoracic Surgery, “Vittorio Emanuele–Policlinico” Hospital , Catania, Italy

    Giacomo Cusumano & Alberto Terminella

  2. Department of Thoracic Surgery, Cochin Hospital, AP-HP, Paris, France

    Ludovic Fournel, Marie Christine Charpentier, Jean Francois Regnard & Marco Alifano

  3. University Paris Descartes, Paris, France

    Ludovic Fournel, Jean Francois Regnard & Marco Alifano

  4. General Thoracic Surgery, “Cannizzaro” Hospital, Catania, Italy

    Salvatore Strano & Maurizio Nicolosi

  5. Department of Pathology, Cochin Hospital, AP-HP, Paris, France

    Diane Damotte & Marie Christine Charpentier

  6. Department of Pathology, “Cannizzaro” Hospital, Catania, Italy

    Antonio Galia

Authors
  1. Giacomo Cusumano
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  2. Ludovic Fournel
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  3. Salvatore Strano
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  4. Diane Damotte
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  5. Marie Christine Charpentier
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  7. Alberto Terminella
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  8. Maurizio Nicolosi
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  10. Marco Alifano
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Corresponding author

Correspondence to Giacomo Cusumano.

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All procedures performed were in accordance with the ethical standards of the each institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals.

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Informed consent was obtained by patients or by their relatives in cases of deceased patients.

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Cusumano, G., Fournel, L., Strano, S. et al. Surgical Resection for Pulmonary Carcinoid: Long-Term Results of Multicentric Study—The Importance of Pathological N Status, More Than We Thought. Lung 195, 789–798 (2017). https://doi.org/10.1007/s00408-017-0056-8

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  • DOI: https://doi.org/10.1007/s00408-017-0056-8

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