A National Study of Surgically Managed Atypical Pulmonary Carcinoid Tumors

Walters, Samantha L.; Canavan, Maureen; Salazar, Michelle C.; Resio, Benjamin J.; Blasberg, Justin D.; Mase, Vincent J.

doi:10.1016/j.athoracsur.2020.09.029

Cited by 13 publications

(7 citation statements)

References 23 publications

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“…While this study is limited by the relatively small patient cohort for more detailed subgroup survival analysis, it boasts the largest patient sample to date, enhanced by the application of G‐computation adjustment. This provides valuable insights that complement the findings of Walters 9 and Chen 10 . Nonetheless, we recognise the intricacies of confounding factors and agree that further investigation is necessary to gain a deeper understanding of how surgical methods impact the prognosis of AC.…”

Section: Discussionsupporting

confidence: 61%

“…Of note, the comparative impact of diverse surgical modalities on the survival of patients with AC is yet to be conclusively established, partly due to the relative rarity of these tumours. Recent studies found that sublobar resection, including segmentectomy and wedge resection, was not inferior to lobectomy for AC‐related survival 9,10 . Nonetheless, this conclusion may be arbitrary due to limited sample size in certain surgical approach and absence of adjustment methodologies to account for confounders within their Kaplan–Meier survival analyses.…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies found that sublobar resection, including segmentectomy and wedge resection, was not inferior to lobectomy for AC‐related survival. 9 , 10 Nonetheless, this conclusion may be arbitrary due to limited sample size in certain surgical approach and absence of adjustment methodologies to account for confounders within their Kaplan–Meier survival analyses. Therefore, a more definitive survival analysis could be achieved with an expanded cohort and refined analytical techniques.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic nomogram and epidemiological analysis for lung atypical carcinoid: A SEER database and external validation study

Yi,

He,

Qian

et al. 2023

Cancer Medicine

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PurposeOur study aims to delineate the epidemiological distribution of pulmonary carcinoids, including atypical carcinoid (AC) and typical carcinoid (TC), identify independent prognostic factors, develop an integrative nomogram and examine the effects of various surgical modalities on atypical carcinoid‐specific survival (ACSS).MethodsJoinpoint regression model and age‐group distribution diagram were applied to determine the epidemiological trend of the pulmonary carcinoids. Univariate and least absolute shrinkage and selection operator (LASSO)‐based Cox regression models were used to identify independent factors, and a nomogram and web‐based predictor were developed to evaluate prognosis of AC patients individually. We performed Kaplan–Meier survival analyses to compare the scope of various surgical interventions, with and without G‐computation adjustment, utilising restricted mean survival time (RMST) to assess survival disparities.ResultsA total of 1132 patients were recruited from the Surveillance, Epidemiology, and End Results database (SEER) and a separate medical centre in China. The mean age of AC patients was 63.4 years and a smoking history was identified in 79.8% of AC patients. Joinpoint analysis shows rising annual rates of new AC and carcinoid cases among lung cancers. Both the proportion of pulmonary TC and AC within the total lung cancer population exhibits an L‐shaped trend across successive age groups. The nomogram predicted 1, 3 and 5 years of AC with excellent accuracy and discrimination. Kaplan–Meier survival analyses, conducted both pre‐ and post‐adjustment, demonstrated that sublobar resection's survival outcomes were not inferior to those of lobectomy in patients with stage I‐II and stage III disease.ConclusionThis study is the first to reveal epidemiological trends in pulmonary carcinoids over the past decade and across various age cohorts. For patients with early‐stage AC, sublobar resection may be a viable surgical recommendation. The established nomogram and web‐based calculator demonstrated decent accuracy and practicality.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic nomogram and epidemiological analysis for lung atypical carcinoid: A SEER database and external validation study

Yi,

He,

Qian

et al. 2023

Cancer Medicine

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“…Lymph node metastases have been shown to be associated with an inferior survival rate in patients with AC (19). In a recent national study of surgically managed AC (n=816), no significant difference in mortality was observed between lobectomy and sublobectomy (23). Similar to TC, it can be suggested that the extent of lymphadenectomy in AC seems to be more important than the extent of lung resection.…”

Section: Atypical Carcinoid (N=97)mentioning

confidence: 99%

Prognostic factors in resected pulmonary carcinoid tumors: A retrospective study with 10 years of follow‑up

Ernani

Liu

et al. 2023

Oncol Lett

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The objective of the present study was to characterize the difference in 10-year carcinoid-specific survival (CSS) and disease-free survival (DFS) among patients with resected pulmonary typical carcinoid (TC) and atypical carcinoid (AC). Patients diagnosed with pulmonary carcinoid tumors (PCT) between January 1, 1997, and December 31, 2016, were identified. All patients underwent video-assisted thoracoscopic surgery or thoracotomy with thoracic lymphadenectomy. Cumulative CSS was estimated using the Kaplan-Meier model. The analysis of hazard ratios (HRs) and 95% confidence intervals (CIs) was performed using univariate and multivariate Cox proportional hazards models. A total of 404 patients with PCT were included in the present study. The 10-year CSS and DFS rates of patients with AC were significantly worse than those of patients with TC (49.1 vs. 86.8% and 52.2 vs. 92.6%, respectively; P<0.001). In the CSS multivariate analysis, older age and lymph node involvement (HR, 2.45; P= 0.022) were associated with worse survival in AC, while age, male sex, M1 stage, cigarette smoking and inadequate N2 lymphadenectomy were associate with worse survival in TC. In the recurrence multivariate analysis, N1-3 stage (HR, 2.62; 95% CI, 1.16-5.95; P= 0.018) and inadequate N2 lymphadenectomy (HR, 2.13; 95% CI, 1.04-4.39; P=0.041) were associated with an increase in recurrence in AC, while male sex (HR, 3.72; 95% CI, 1.33-10.42; P=0.010) and M1 stage (HR, 14.93; 95% CI, 4.77-46.77; P<0.001) were associated with an increase in recurrence in TC. In conclusion, patients with AC tumors had significantly worse CSS and DFS rates compared with patients with TC. The degree of nodal involvement in AC was a prognostic marker, in contrast to that in TC. Inadequate lymphadenectomy increased the risk of recurrence in AC and mortality in TC, although surgical approaches did not have a significant impact. The present study therefore emphasizes the importance of mediastinal nodal dissection in patients with PCTs.

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“…Lung carcinoid (LC) tumors are rare neuroendocrine neoplasms that represent less than 2% of all lung malignancies (1,2). However, the incidence of LC is increasing, likely related to improved imaging and other diagnostic techniques (2,3). The World Health Organization (WHO) classifies LC into typical (TC) and atypical (AC) carcinoids (4).…”

Section: Introductionmentioning

confidence: 99%

Platin‑based chemotherapy does not improve survival in patients with non‑metastatic resected typical carcinoid tumors

et al. 2022

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Chemotherapy is controversial in non-metastatic typical carcinoid (TC) tumors. Therefore, it was aimed to evaluate the impact of platin-based chemotherapy on the survival of patients with lung TC. The medical records of patients who underwent surgical resection for non-metastatic TC from 2002 to 2020 at our institution were retrospectively reviewed. Multivariate regression analysis was performed for chemotherapy and prognostic factors in disease-free survival (DFS) in 72 patients. The pathological stages of patients were as follows: 73.6% of the patients were in stage I, 15.3% in stage II and 11.1% in stage III. A total of 5 patients (6.9%) received platin-based chemotherapy and 6 patients (8.3%) had recurrences. The DFS rates at 12, 36 and 60 months were 98.5, 95.1 and 92.5%, respectively. Log-rank testing showed that patients who received chemotherapy and had stage III disease had shorter DFS (P=0.021 for chemotherapy and P<0.001 for stage). However, multivariate analysis revealed that the pathological stage was the only statistically significant factor affecting DFS (P=0.016). Platin-based chemotherapy did not improve DFS, and the eighth edition of TNM (tumor, nodes, metastases) staging did have prognostic value for patients with non-metastatic TC. Although resection has satisfying long-term outcomes, studies on new agents are needed to decrease the recurrence rate, particularly in patients with stage III disease.

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A National Study of Surgically Managed Atypical Pulmonary Carcinoid Tumors

Cited by 13 publications

References 23 publications

Prognostic nomogram and epidemiological analysis for lung atypical carcinoid: A SEER database and external validation study

Prognostic nomogram and epidemiological analysis for lung atypical carcinoid: A SEER database and external validation study

Prognostic factors in resected pulmonary carcinoid tumors: A retrospective study with 10 years of follow‑up

Platin‑based chemotherapy does not improve survival in patients with non‑metastatic resected typical carcinoid tumors

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