Outcomes after surgical resection of pulmonary carcinoid tumors
Okereke et al. Journal of Cardiothoracic Surgery
Outcomes after surgical resection of pulmonary carcinoid tumors
Ikenna C. Okereke 0
Angela M. Taber 2
Rogers C. Griffith 1
Thomas T. Ng 3
0 Cardiothoracic Surgery, University of Texas Medical Branch , 301 University Blvd, Galveston, TX 77555 , USA
1 Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University , Providence, RI , USA
2 Division of Oncology, Warren Alpert Medical School of Brown University , Providence, RI , USA
3 Department of Surgery, Warren Alpert Medical School of Brown University , Providence, RI , USA
Background: Pulmonary carcinoid tumors make up approximately one percent of all pulmonary tumors, and controversy exists regarding management and prognosis. We undertook a retrospective analysis of all patients who underwent surgical resection of pulmonary carcinoid tumors at our institution. Methods: From 1992 through 2014, 121 patients who underwent surgical resection of pulmonary carcinoid tumors were retrospectively reviewed. Patient demographics, pathologic data and long-term outcomes were recorded. Results: There were 96 patients with typical carcinoid tumors and 25 patients with atypical carcinoid tumors. All patients received complete resection of their tumors, with 90 % (109/121) of patients undergoing anatomic resection. There were no peri-operative mortalities. Eighty-one percent (98/121) of patients were female. Mean age was 60.7 years. Five and ten year survival rates were 96 % and 88 % respectively for typical carcinoid tumors, as compared to 87 % and 69 % respectively for atypical carcinoid tumors. Tumor size was not associated with survival (p = 0.98). Nodal metastases were evident in 8 % (8/96) of typical carcinoid tumors and 28 % (7/25) percent of atypical carcinoid tumors. Among typical carcinoid cases, the presence of nodal metastases were not associated with overall survival (p = 0.55). Among atypical carcinoid cases, the presence of nodal metastases also was not associated with survival (p = 0.53). No patients received neoadjuvant or adjuvant chemoradiation treatment. Conclusions: Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoid tumors. The presence of nodal metastases was not associated with overall survival. Tumor size was not associated with either recurrence rates or survival.
Carcinoid; Lymphadenopathy; Mitosis
Background
Pulmonary carcinoid tumors make up approximately 1–
2 % of all pulmonary tumors [1]. They are derived from
the Kulchitsky cell and generally have indolent growth
patterns. Carcinoid tumors are categorized as typical or
atypical, based on number of mitoses per high power
field and presence of necrosis [2]. Surgical resection is
the standard treatment for pulmonary carcinoid tumors
[3]. There exists debate, however, about the use of
adjuvant treatment in patients with locoregional
metastases or patients with atypical tumors [4, 5]. We
undertook a retrospective review to determine the outcomes
of patients with pulmonary carcinoid tumors who
underwent surgical resection.
Methods
After approval by the institutional review board, a
database search for pulmonary carcinoid tumors was
performed from pathology records of two Brown University
hospitals (The Rhode Island Hospital and The Miriam
Hospital) over a 22 year period (1992–2014). Over this
time span, 121 patients with pulmonary carcinoid
tumors underwent surgical resection. Patients who were
incidentally found to have a carcinoid tumorlet as part
of their resection specimen were not included in the
study. Pathologic confirmation of carcinoid tumor was
established by a pathologist in all cases. Tumors were
classified as typical carcinoid if there were less than 2
mitoses per 2 square millimeters (mm2) and no necrosis.
Tumors were classified as atypical if there were between
2 and 10 mitoses per mm2 or evidence of necrosis.
Patient demographics, use of chemotherapy or radiation,
peri-operative variables, type of surgical resection,
recurrence rates and survival were analyzed retrospectively.
Anatomic resection consisted of either segmentectomy,
lobectomy, bi-lobectomy or pneumonectomy. Follow-up
status was obtained from institutional records and
verified by the national social security database.
The Mann–Whitney test was used to compare
differences in continuous variables between different tumor
groups. Fisher’s exact and Chi-squared tests were used
to compare categorical variables. Univariate survival
analysis was performed using Kaplan-Meier curves
compared with log rank or Cox regression analysis.
Multivariate survival analysis was performed with Cox
regression analysis, using variables with a p-value of less
than 0.1 on univariate analysis.
Results
Patients
A list of patient demographics is shown in Table 1.
Eighty-one percent (98/121) of the patients were female.
Mean age was 60.7 years (
11–81
). Mean follow-up time
was 70.2 months (
1–259
).
Surg (...truncated)