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

Lin Du; Vinicius Ernani; Alex Liu; Steven E Schild; Dawn E Jaroszewski; Steven D Cassivi; Staci E Beamer; Yung-Hung Luo; Jason A Wampfler; Pedro A Reck Dos Santos; Dennis Wigle; Daqiang Sun; K Robert Shen; Ping Yang

doi:10.3892/ol.2023.13666

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

Oncol Lett. 2023 Jan 10;25(2):80. doi: 10.3892/ol.2023.13666. eCollection 2023 Feb.

Authors

Lin Du^{1

2

3}, Vinicius Ernani⁴, Alex Liu⁴, Steven E Schild⁵, Dawn E Jaroszewski⁶, Steven D Cassivi⁷, Staci E Beamer⁶, Yung-Hung Luo^{8

9

10

11

12}, Jason A Wampfler¹², Pedro A Reck Dos Santos⁶, Dennis Wigle⁷, Daqiang Sun^{1

3}, K Robert Shen⁷, Ping Yang²

Affiliations

¹ Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300222, P.R. China.
² Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ 85260, USA.
³ Graduate School, Tianjin Medical University, Tianjin 300070, P.R. China.
⁴ Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ 85260, USA.
⁵ Division of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85260, USA.
⁶ Division of Thoracic Surgery, Mayo Clinic, Scottsdale, AZ 85260, USA.
⁷ Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
⁸ Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA.
⁹ Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, R.O.C.
¹⁰ Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C.
¹¹ School of Medicine, National Yang-Ming University, Taipei 112, Taiwan, R.O.C.
¹² Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA.

Abstract

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.

Keywords: atypical carcinoid; lymphadenectomy; prognostic factors; pulmonary carcinoid tumor; surgery; typical carcinoid.

Abstract

Grants and funding