Evaluation of the Prognostic Significance of TNM Staging Guidelines in Lung Carcinoid Tumors

Abstract

Introduction: The TNM classification for lung cancer, originally designed for NSCLC, is applied to staging of bronchopulmonary carcinoid tumors. The validity of the eighth edition of the staging system for carcinoid tumors has not been assessed. In this study, we evaluated its prognostic accuracy by using data from a large national population-based cancer registry.Methods: Patients with typical and atypical bronchopulmonary carcinoids diagnosed between 2000 and 2013 were identified from the National Cancer Institute's Surveillance, Epidemiology and End Results registry. We used competing risks analysis to compare 10-year diseasespecific survival (DSS) across stages.Results: Overall, 4645 patients with bronchopulmonary carcinoid tumors were identified. Worsening DSS with increasing TNM status and stage was demonstrated across both typical and atypical carcinoids, with overlaps between adjacent subcategories. The combined stages (I versus II, II versus III, and III versus IV) showed greater separation in DSS despite persistent overlaps between groups. For typical carcinoids, we found decreased DSS for stages II, III, and IV, with hazard ratios of 3.8 (95% confidence interval [CI]: 2.6-5.6), 4.3 (95% CI: 3.0-6.1), and 9.0 (95% CI: 6.1-13.1), respectively, compared with stage I. Conclusion:The combined stage categories of the eighth edition of the TNM staging system provide useful information on outcomes for typical and atypical carcinoids. However, persistent overlaps in combined stage and subcategories of the staging system limit the usefulness of the TNM staging system, particularly in intermediate stages. These limitations suggest the need for future further study and refinement.

The role of surgery for atypical bronchopulmonary carcinoid tumor: Development and validation of a model based on Surveillance, Epidemiology, and End Results (SEER) database

“…Because of its relatively uncommon nature, no specific clinical prognostic tool exists for AC. Previous studies suggested the staging of pulmonary NETs according to the American Joint Committee on Cancer (AJCC) staging system [7]. Nonetheless, this suggestion is questionable given the very different biology, variable clinical presentation and therapeutic approaches between pulmonary ACs and other usual histological subtypes of lung cancer (e.g.…”

Prognostic value of fibrinogen‑to‑albumin ratio in patients with gastric cancer receiving first‑line chemotherapy

“…The Union for International Cancer Control TNM classification system is one of the most common methods used by clinicians to evaluate the prognosis of patients with GC (3). However, this system has certain limitations, such as the fact that patients with the same tumor stage may have different clinical outcomes (4,5). Therefore, it is imperative to identify other independent prognostic markers for GC to further classify patients who have been staged according to the TNM system into subgroups with good and poor prognosis.…”

Prognostic significance for colorectal carcinoid tumors based on the 8th edition TNM staging system

“…However, in the early and middle status, HRs did not increase with the increase of stages, or there was no difference in HRs between adjacent stages. Similar grading prognostic results for carcinoid could be seen in lung carcinoid 6 . These findings limited the usefulness of the 8th TNM staging system.…”

“…As the screening popularity of colonoscopy, colorectal carcinoids were more commonly found in the United States, with rectal carcinoids accounting for about 20% 4,5 . Because of the lack of uniform classification standards and relatively special nature, no recognized and unified staging system existed for these tumors 6 . The World Health Organization (WHO) Classification of the Digestive System 2010 used “neuroendocrine neoplasm (NEN)” to bridge this classification gap 2 .…”