Outcomes after surgical resection of pulmonary carcinoid tumors

Journal of Cardiothoracic Surgery, Mar 2016

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.

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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)


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Ikenna Okereke, Angela Taber, Rogers Griffith, Thomas Ng. Outcomes after surgical resection of pulmonary carcinoid tumors, Journal of Cardiothoracic Surgery, 2016, pp. 35, 11, DOI: 10.1186/s13019-016-0424-0