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Ahuja G, Iyer A, Harwood R, Balata H, Craig C, Crosbie PAJ, Hewitt K, Peplow K, Hutchings D, Sharman A, Bishop P, Joseph L, Paiva-Correia A, Chaturvedi A, Barr J, Leek A, Backen A, Nuttall C, Kennedy O, Williamson A, Weaver J, Mansoor W, Evison M. Pathological & radiological variables in the diagnosis of bronchopulmonary carcinoids (BPCs) with a focus on Antigen Kiel 67 (Ki-67) proliferation index. Lung Cancer 2025; 202:108493. [PMID: 40101668 DOI: 10.1016/j.lungcan.2025.108493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 02/20/2025] [Accepted: 03/08/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Bronchopulmonary carcinoids (BPCs) are classified into typical carcinoids (TC) and atypical carcinoids (AC), based on the mitotic count and absence/presence of necrosis on pathology specimens. There are limitations to accurate measurement of these criteria. It important to study other markers like Ki-67, to enhance the diagnostic accuracy of lung carcinoids. OBJECTIVE AND METHODOLOGY Retrospective analysis of BPCs treated with surgery between 2012-2022, to examine the accuracy of Ki-67 on the diagnostic specimen, concordance of diagnostic and resection specimens, diagnostic accuracy of Positron Emission Tomography (PET) and concordance of clinical and pathological staging. RESULTS 205 patients were included in the analysis (final diagnosis TC 180, AC 25). Mean age 60.5 years and 68 % female. Ki-67 (<5% vs. 5-30 %) on diagnostic biopsy, available in 64 % (n = 131) of the cohort, had specificity (diagnose TC correctly) of 89.4 % (95 %CI 80.4 %-94.7 %) and sensitivity (diagnose AC correctly) of 77.8 % (40.2 %-96.1 %). This compared to 97.5 % (90.3 %-99.6 %) and 36.4 % (12.4 %-68.4 %) for mitotic count (<2mitoses/2mm2 vs. 2-10mitoses/2mm2) and 100 % (94.4 %-100 %) and 21.4 % (5.7 %-51.2 %) for necrosis (absence vs. presence). A pre-resection diagnosis of TC (including surgical biopsy) shows better concordance with final diagnosis on resection specimen (94.9 %, 95 %CI 88.7 %-97.9 %, n = 117) as compared to the diagnosis of AC 83.3 % (95 %CI 50.9 %-97.1 %, n = 12). Concordance for AC appears higher with image guided lung biopsy 80 % (95 % CI, 29.9 %-98.9 %) than bronchoscopy 50 % (9.5 %-90.5 %). SUVmax on 18FDG-PET was a modest predictor of BPC sub-type with an AUC of 0.684 (95 % CI: 0.545,0.823). The clinical and pathological staging were concordant in 46 % (85/184) cases. However, 27 % (50/184) were upstaged and 13 % (23/172) found to have occult nodal metastases on pathology review of the surgical specimens. CONCLUSION The diagnosis and sub-typing of BPCs on diagnostic specimens is challenging. Our data suggest Ki-67 could increase diagnostic accuracy, but further research is needed to confirm this.
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Affiliation(s)
- Gaurav Ahuja
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland.
| | - Aparna Iyer
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Rachel Harwood
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, the United Kingdom of Great Britain and Northern Ireland; Statistics, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Haval Balata
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Christopher Craig
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Philip A J Crosbie
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland; Division of Immunology, Immunity to Infection & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Kath Hewitt
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Karen Peplow
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Deborah Hutchings
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Anna Sharman
- Department of Radiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Paul Bishop
- Department of Histopathology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Leena Joseph
- Department of Histopathology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Antonio Paiva-Correia
- Department of Histopathology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Anshuman Chaturvedi
- Department of Histopathology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland; The Christie NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - James Barr
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Angela Leek
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Alison Backen
- The Christie NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland; Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Christina Nuttall
- The Christie NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Oliver Kennedy
- The Christie NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Andrew Williamson
- The Christie NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Jamie Weaver
- The Christie NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Wasat Mansoor
- The Christie NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland; Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, the United Kingdom of Great Britain and Northern Ireland
| | - Matthew Evison
- Lung Cancer and Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, the United Kingdom of Great Britain and Northern Ireland; Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, the United Kingdom of Great Britain and Northern Ireland
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Askildsen E, Soldath P, Langer SW, Andreassen M, Knigge U, Petersen RH. Recurrence Rates and Patterns after Radical Resection of Lung Carcinoids. Cancers (Basel) 2024; 16:2978. [PMID: 39272839 PMCID: PMC11394051 DOI: 10.3390/cancers16172978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/22/2024] [Accepted: 08/25/2024] [Indexed: 09/15/2024] Open
Abstract
Atypical lung carcinoid (AC) is widely accepted to recur more often after radical resection than typical lung carcinoid (TC). However, their recurrence rates have never been compared in a multi-state competing risks model. We retrospectively reviewed files from patients with AC and TC who had been radically resected at our European Neuroendocrine Tumor Society Center of Excellence between 2009 and 2020. We estimated the recurrence rates between the AC and TC patients counting unrelated death as a competing event using Aalen-Johansen estimates and compared them using a multi-state Cox model. Finally, we analyzed all AC and TC recurrences as to resection type, pathological stage, resection margin, recurrence site, and time to recurrence. The study included 217 patients, of whom 194 had TC and 23 had AC. The median follow-up was 9.4 years. The AC patients experienced recurrence at a higher rate (hazard ratio [HR] 16.0, 95% confidence interval [CI] 5.3-47.9, p < 0.001). Correspondingly, the 5- and 10-year recurrence rates were 18% and 32% for AC and merely 1.0% and 2.4% for TC. In patients without nodal involvement, AC recurred at a considerably higher rate (HR 41.2, 95% CI 8.7-194.8, p < 0.001) than TC. In both AC and TC, most recurrences were distant and occurred in patients with a resection margin less than 2 cm. We conclude that AC recurs more often than TC, even in patients without nodal involvement at surgery, suggesting that all AC patients regardless of their pathological stage should undergo close follow-up care after surgery.
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Affiliation(s)
- Erika Askildsen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Patrick Soldath
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Seppo W Langer
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Mikkel Andreassen
- Department of Endocrinology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ulrich Knigge
- Department of Endocrinology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
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3
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Spils M, Klikovits T, Krenbek D, Hochmair MJ, Jankovic I, Schulte L, Krajc T, Benej M, Getman V, Navarrete JR, Akan A, Mueller MR, Aigner C, Watzka SB. Prognostic factors of recurrence and disease-free survival in radically resected pulmonary carcinoids: a real-world analysis. J Thorac Dis 2024; 16:1911-1922. [PMID: 38617753 PMCID: PMC11009585 DOI: 10.21037/jtd-23-1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/02/2024] [Indexed: 04/16/2024]
Abstract
Background Pulmonary carcinoids (PCs) are rare neuroendocrine lung tumors which may recur, thus worsening their otherwise favorable overall prognosis. Aiming to identify patients at risk for recurrence, we examined parameters affecting disease-free survival (DFS). Methods A retrospective single-center analysis of 82 consecutive patients undergoing curative intent resection for primary PC tumors between 2010 and 2019 was carried out. Kaplan-Meier method was utilized for survival analysis. Independent prognostic factors were determined using multivariable Cox and logistic regression. Results During the observation period 82 patients, 48 females (58.5%) and 34 males (41.5%) were operated, representing 84 cases of PCs, 56 typical (TCs) (66.7%) and 28 atypical (ACs) (33.3%) carcinoids. Five-year overall survival was 87.5% and 84.7%, 5-year DFS 97.5% and 74.9% (P=0.012) for TCs and ACs, respectively. Recurrences occurred in one patient (1.8%) with TCs and five patients (17.9%) with ACs (P=0.014). Using multivariable Cox regression, tumor size (cm) remained as an independent prognostic factor for reduced DFS (P=0.018). In logistic regression, nodal involvement (P=0.043) and tumor size (cm) (P=0.023) were independently associated with higher risk of recurrence. Age, sex, smoking, location, and Ki-67 index were not independently associated with recurrence or DFS. Conclusions Recurrence in PCs after complete resection is relatively rare. However, DFS is reduced in ACs compared to TCs. Tumor size (cm) and nodal involvement appear as the most important prognostic factors associated with recurrence in PCs, independent of histologic type.
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Affiliation(s)
- Marc Spils
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Thomas Klikovits
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Dagmar Krenbek
- Institute for Pathology, Clinic Floridsdorf, Vienna, Austria
| | - Maximilian Johannes Hochmair
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Clinic Floridsdorf, Vienna, Austria
| | - Igor Jankovic
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Lisa Schulte
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Tibor Krajc
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Michal Benej
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Vladyslav Getman
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - José Ruiz Navarrete
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Ahmet Akan
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Michael R. Mueller
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
| | - Clemens Aigner
- Department of Thoracic Surgery, Vienna General Hospital, Vienna, Austria
| | - Stefan B. Watzka
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, Vienna, Austria
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Jafari P, Husain AN, Setia N. All Together Now: Standardization of Nomenclature for Neuroendocrine Neoplasms across Multiple Organs. Surg Pathol Clin 2023; 16:131-150. [PMID: 36739160 DOI: 10.1016/j.path.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neuroendocrine neoplasms (NENs) span virtually all organ systems and exhibit a broad spectrum of behavior, from indolent to highly aggressive. Historically, nomenclature and grading practices have varied widely across, and even within, organ systems. However, certain core features are recapitulated across anatomic sites, including characteristic morphology and the crucial role of proliferative activity in prognostication. A recent emphasis on unifying themes has driven an increasingly standardized approach to NEN classification, as delineated in the World Health Organization's Classification of Tumours series. Here, we review recent developments in NEN classification, with a focus on NENs of the pancreas and lungs.
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Affiliation(s)
- Pari Jafari
- Department of Pathology, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Room S-638, Chicago, IL 60637, USA.
| | - Aliya N Husain
- Department of Pathology, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Room S-638, Chicago, IL 60637, USA
| | - Namrata Setia
- Department of Pathology, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6101, Room S-638, Chicago, IL 60637, USA
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Du L, Ernani V, Liu A, Schild SE, Jaroszewski DE, Cassivi SD, Beamer SE, Luo YH, Wampfler JA, Santos PARD, Wigle D, Sun D, Shen KR, Yang P. Prognostic factors in resected pulmonary carcinoid tumors: A retrospective study with 10 years of follow‑up. Oncol Lett 2023; 25:80. [PMID: 36742364 PMCID: PMC9853094 DOI: 10.3892/ol.2023.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
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.
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Affiliation(s)
- Lin Du
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300222, P.R. China
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ 85260, USA
- Graduate School, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Vinicius Ernani
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ 85260, USA
| | - Alex Liu
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ 85260, USA
| | - Steven E. Schild
- Division of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85260, USA
| | | | - Steven D. Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Staci. E. Beamer
- Division of Thoracic Surgery, Mayo Clinic, Scottsdale, AZ 85260, USA
| | - Yung-Hung Luo
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan, R.O.C
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan, R.O.C
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan, R.O.C
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Jason A. Wampfler
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Dennis Wigle
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300222, P.R. China
- Graduate School, Tianjin Medical University, Tianjin 300070, P.R. China
| | - K. Robert Shen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Ping Yang
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ 85260, USA
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Gao C, Zhang J, Wang Y, Huang C, Zhang Y, Chen Y, Li S. Patients with ectopic ACTH syndrome might have a better prognosis in bronchopulmonary carcinoids with lymph node metastasis received radical surgery: a single-centre retrospective study in the last 22 years in China. BMC Surg 2022; 22:383. [PMID: 36348311 PMCID: PMC9641947 DOI: 10.1186/s12893-022-01831-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bronchopulmonary carcinoids (BPCs) are rare malignancies but are known to be one of the most common causes of the ectopic adrenocorticotropic hormone (ACTH) syndrome. Surgery is the mainstay of therapy and one key question considering surgical treatment is the impact of local lymph node metastases. We sought to determine the risk factors and prognosis of LN metastases in resected carcinoid patients. Methods Data of 42 patients of BPCs with lymph node metastasis who received radical surgery in Peking Union Medical College Hospital (PUMCH) from Jan 2000 to Dec 2021 were retrospectively analysed. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan–Meier curves. Independent prognostic factors were assessed by COX hazard proportion model. Results It was indicated that in patients received radical surgery with local lymph node positive of BPCs, the 5-year OS and PFS rate was 74.5%, 68.3%, respectively. Multivariate Cox regression indicated that ectopic ACTH syndrome (EAS) could predict significantly to a better OS and PFS. In the subgroup analysis, the age, tumor size, Ki-67 index, histology and postoperative chemotherapy in patients with EAS had significantly differences with those without EAS. Conclusions Our study certified R0 resection with lymphadenectomy was effective in patients with lymph nodal positive. The ectopic ACTH syndrome was a protective factor for a better prognosis, which could provide clear evidence for operations.
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La Salvia A, Carletti R, Verrico M, Feola T, Puliani G, Bassi M, Sesti F, Pernazza A, Mazzilli R, Lamberti G, Siciliani A, Mancini M, Manai C, Venuta F, Ibrahim M, Tomao S, D’Amati G, Di Gioia C, Giannetta E, Cappuzzo F, Faggiano A. Angioside: The role of Angiogenesis and Hypoxia in Lung Neuroendocrine Tumours According to Primary Tumour Location in Left or Right Parenchyma. J Clin Med 2022; 11:5958. [PMID: 36233825 PMCID: PMC9570740 DOI: 10.3390/jcm11195958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Well-differentiated lung neuroendocrine tumours (Lu-NETs), classified as typical (TC) and atypical (AC) carcinoids, represent 30% of NETs. Angiogenesis plays an essential role in NET development and progression. A higher vascular network is a marker of differentiation, with positive prognostic implications. Materials and Methods: We retrospectively evaluated microvessel density (MVD) by CD34 immunohistochemical (IHC) staining and hypoxia by IHC staining for Hypoxia-inducible factor 1α (HIF-1α), comparing right- and left-lung parenchyma in 53 lung NETs. Results: The median age was 66 years (39−81), 56.6% males, 24.5% AC, 40.5% left-sided tumours and 69.8% TNM stage I. The mitotic count was <2/10 per 10 HPF in 79.2%, and the absence of necrosis in 81.1%, 39.6% with Ki67, was ≤2%. The MVD, the number of vessels and the average vessel area median values were significantly higher in the right than the left parenchyma (p: 0.025, p: 0.019, p: 0.016, respectively). Hypoxia resulted present in 14/19 (73.6%) left tumours and in 10/20 (50%) right tumours in the parenchyma (p: 0.129). Conclusions: This study suggests a biological rationale for a different angiogenesis and hypoxia according to the Lu-NETs’ location. In our study, left primary tumours were less vascularized and most likely to present hypoxia than right primary tumours. This finding could have potentially useful prognostic and predictive implications for Lu-NETs.
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Affiliation(s)
- Anna La Salvia
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Raffaella Carletti
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Monica Verrico
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, 86077 Pozzilli, Italy
| | - Giulia Puliani
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Massimiliano Bassi
- Department of Thoracic Surgery, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Angelina Pernazza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Rome, Italy
| | - Rossella Mazzilli
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00185 Rome, Italy
| | - Giuseppe Lamberti
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy
| | - Alessandra Siciliani
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Massimiliano Mancini
- Division of Morphologic and Molecular Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Chiara Manai
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Giulia D’Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Cira Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Antongiulio Faggiano
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00185 Rome, Italy
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Thakur S, Florisson D, Telianidis S, Yaftian N, Lee J, Knight S, Barnett S, Seevanayagam S, Antippa P, Alam N, Wright G. Pulmonary carcinoid tumours: A multi-centre analysis of survival and predictors of outcome following sublobar, lobar, and extended pulmonary resections. Asian Cardiovasc Thorac Ann 2021; 29:532-540. [PMID: 33853389 DOI: 10.1177/02184923211010090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary carcinoids are rare neoplasms, accounting for approximately 1%-2% of all lung malignancies. A retrospective analysis was undertaken of all patients who underwent surgical resection of pulmonary carcinoid tumours across multiple institutions in Melbourne, Australia. METHODS From May 2000 through April 2020, 241 patients who underwent surgical resection of pulmonary carcinoid tumours were retrospectively reviewed. Patient demographics, pathologic data, and long-term outcomes were recorded. RESULTS Median age was 57.7 years and the majority of patients were female (58.9% vs. 41.1%). Typical carcinoid was present in 77.1%. Histological subtype was associated with several factors. Atypical carcinoid was more likely to have larger tumour size and nodal involvement. Overall survival for typical carcinoid at 5, 10, and 15 years was 98%, 95%, and 84%, and for atypical carcinoid was 88%, 82%, and 62%, respectively. Histological subtype and age were found to be independent predictors of overall survival, with worse outcomes for atypical and those above 60 years of age. Disease-free survival was related to sublobar resection (p < 0.001, sub-hazard ratio (SHR): 6.89), lymph node involvement (p = 0.022, SHR: 3.18), and atypical histology (p < 0.001, SHR: 9.89). CONCLUSION Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoids. Atypical histology and lymph node involvement are significant prognostic factors, and sublobar resection should not be considered in patients with either of the above features. Typical carcinoid tumour without nodal involvement may be appropriate for sublobar resection. Typical and atypical carcinoid tumours should be considered distinct disease entities, and as such treated accordingly.
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Affiliation(s)
- Sameer Thakur
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Daniel Florisson
- Department of Thoracic Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Stacy Telianidis
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Nima Yaftian
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jean Lee
- Department of Medical Imaging, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Simon Knight
- Department of Thoracic Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Stephen Barnett
- Department of Thoracic Surgery, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Siven Seevanayagam
- Department of Thoracic Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter McCallum Cancer Centre, Parkville, Victoria, Australia
| | - Naveed Alam
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Gavin Wright
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter McCallum Cancer Centre, Parkville, Victoria, Australia
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9
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García-Fontán EM, Cañizares-Carretero MÁ, Blanco-Ramos M, Matilla-González JM, Carrasco-Rodríguez R, Barreiro-Morandeira F, García-Yuste M. Prognostic significance of histopathological factors in survival and recurrence of atypical carcinoid tumours. Interact Cardiovasc Thorac Surg 2021; 32:904-910. [PMID: 33580683 DOI: 10.1093/icvts/ivab026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 12/10/2020] [Accepted: 01/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Atypical carcinoids are neuroendocrine neoplasms of intermediate degree and low frequency. The aim of this study is to analyse their clinical characteristics and the importance of different histopathological factors in their prognosis. METHODS Multicentre cooperative group EMETNE prospectively reviewed 153 patients operated on between 1998 and 2016 with diagnosis of atypical carcinoids. Clinical variables and histopathological features were assessed. RESULTS Mean age was 54.36 years, similar for both genders. Concerning pathological study, mean tumour size was 31.7 mm. Rosettes were presented in 17% of the cases and tumoural necrosis in 23.3%. The cell proliferation factor Ki-67 index was 10.7%. The 2- and 5-year overall survival rates were 95.8% and 88.9%, respectively. In the univariate study, statistically significant differences in survival were found for each of the categories of T, N and M factors. Mitotic index and quantification of expression of Ki-67 showed influence in overall survival, although without statistical significance. In the multivariate analysis, factors N, M and mitotic index behaved as independent prognostic factors related to survival. Median disease-free interval in the series was 163.35 months. In cases with loco-regional recurrence, 53% had positive hiliar or mediastinal nodal involvement at the time of the surgery. In the univariate analysis, we observed statistically significant differences in disease-free interval in patients with nodal involvement (P = 0.024) and non-anatomical resections (P = 0.04). Histological characteristics showed no statistically significant differences in disease-free interval. CONCLUSIONS Lymph node involvement, the development of distant metastasis and mitotic index, more than Ki-67 determination, were shown as independent prognostic factors related to survival of these patients.
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10
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Vesterinen T, Salmenkivi K, Mustonen H, Kuopio T, Lappi-Blanco E, Paavonen T, Vainio P, Knuuttila A, Carpén O, Haglund C, Arola J. Performance of Finnish biobanks in nationwide pulmonary carcinoid tumour research. Virchows Arch 2019; 476:273-283. [PMID: 31385069 PMCID: PMC7028842 DOI: 10.1007/s00428-019-02625-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022]
Abstract
Finnish hospital-integrated biobanks administer millions of formalin-fixed paraffin-embedded tissue samples collected within the clinical diagnostics. According to the Finnish Biobank Act, these samples can be coupled with patients' clinical follow-up data and the data retrieved from national health registries. We collected a nationwide pulmonary carcinoid tumour series from Finnish biobanks to study prognostic factors as well as to explore how the number of tumours found in the Finnish biobanks corresponds to the number of tumours registered by the Finnish Cancer Registry (FCR). Finnish biobanks identified 88% of the tumours registered by the FCR and were able to deliver 63%. The main reasons for lacking samples were paucity of resected primary tumour tissue, incompatible primary diagnosis, and the absence of tissue blocks in the archives. The main bottleneck in the sample application process was retrieving patient data. Altogether, we received 224 tumour samples with appropriate patient data and identified six prognostic factors for shorter disease-specific survival: age over 56 years at the time of diagnosis, tumour size over 2.5 cm, atypical histology, Ki-67 proliferation index higher than 2.5%, hilar/mediastinal lymph node involvement at the time of diagnosis, and the presence of metastatic disease. In conclusion, the Finnish biobank infrastructure offers excellent opportunities for tissue-based research. However, to be able to develop the biobank operations further, involving more medical knowledge in the sample and data acquisition process is a necessity. Also, when working with tissue samples collected over decades, histological expertise is essential for re-evaluation and re-classification of the samples.
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Affiliation(s)
- Tiina Vesterinen
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, Helsinki, Finland.
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Tukholmankatu 8, Helsinki, Finland.
| | - Kaisa Salmenkivi
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, Helsinki, Finland
| | - Harri Mustonen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland
| | - Teijo Kuopio
- Department of Biological and Environmental Science, University of Jyväskylä, Survontie 9, Jyväskylä, Finland
- Department of Pathology, Central Finland Health Care District, Keskussairaalantie 19, Jyväskylä, Finland
| | - Elisa Lappi-Blanco
- Department of Pathology, Center for Cancer Research and Translational Medicine, Oulu University Hospital and University of Oulu, Aapistie 5, Oulu, Finland
| | - Timo Paavonen
- Department of Pathology, Fimlab Laboratories and Department of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, Finland
| | - Paula Vainio
- Department of Pathology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland
| | - Aija Knuuttila
- Department of Pulmonary Medicine, Heart and Lung Center, and Cancer Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland
| | - Olli Carpén
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Haartmaninkatu 8, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, Helsinki, Finland
| | - Johanna Arola
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, Helsinki, Finland
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11
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Vesterinen T, Mononen S, Salmenkivi K, Mustonen H, Räsänen J, Salo JA, Ilonen I, Knuuttila A, Haglund C, Arola J. Clinicopathological indicators of survival among patients with pulmonary carcinoid tumor. Acta Oncol 2018; 57:1109-1116. [PMID: 29463166 DOI: 10.1080/0284186x.2018.1441543] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pulmonary carcinoids (PC) are rare malignant neoplasms that cover approximately 1% of all lung cancers. PCs are classified by histological criteria as either typical (TC) or atypical (AC). Histological subtype is the most studied prognostic factor. The aim of this study was to evaluate if other tissue or clinical features are associated with patient outcomes. MATERIAL AND METHODS We retrospectively reviewed clinical records of 133 PC patients who underwent operation in the Helsinki University Hospital between 1990 and 2013. Tissue specimens were re-evaluated, processed into tissue microarray format and stained immunohistochemically with serotonin, calcitonin, adrenocorticotropic hormone (ACTH), thyroid transcription factor-1 (TTF-1) and Ki-67. Survival and risk analyses were performed. RESULTS Based on histology, 75% (n = 100) of the tumors were TCs and 25% (n = 33) ACs. TCs had higher 10-year disease-specific survival (DSS) rate than ACs (99% (95% CI, 93-100%) for TCs vs. 82% (95% CI, 61-92%) for ACs). Hormonally active tumors expressing serotonin, calcitonin or ACTH were noted in 53% of the specimens but hormonal expression was not associated with DSS. TTF-1 was positive in 78% of the specimens but was not associated with DSS. Ki-67 index varied between <1% and 15%. Ki-67 ≥ 2.5% was associated with shorter DSS (p = .004). The presence of metastatic disease (p = .001), tumor size ≥30 mm (p = .021) and atypical histology (p = .011) were also associated with disease-specific mortality. CONCLUSIONS We conclude that PCs are uncommon tumors. When resected, the long-term survival is in general favorable. In this consecutive, single-institution cohort of patients, presence of metastatic disease, tumor size, histological subtype and Ki-67 index were associated with shorter disease-specific survival. As TC and AC have different clinical behaviors, the correct tumor classification at the time of diagnosis is a necessity.
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Affiliation(s)
- Tiina Vesterinen
- HUSLAB, Helsinki Biobank, Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Sanna Mononen
- Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Kaisa Salmenkivi
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Mustonen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Räsänen
- Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Jarmo A. Salo
- Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Ilonen
- Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Aija Knuuttila
- Department of Pulmonary Medicine, Heart and Lung Center, and Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Johanna Arola
- HUSLAB, Helsinki Biobank, Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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12
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Ueno T, Maki Y, Sugimoto R, Yamashita M, Nakata K, Sugawara Y, Nishimura R, Teramoto N. Surgical outcomes in 13 patients with bronchopulmonary carcinoid tumors including one recurrent oncocytic carcinoid tumor. Gen Thorac Cardiovasc Surg 2018; 67:486-489. [PMID: 29971648 DOI: 10.1007/s11748-018-0967-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/27/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Bronchopulmonary carcinoids are low-grade tumors for which the standard treatment is surgical resection. We retrospectively evaluated the surgical outcomes. METHODS Thirteen patients underwent surgical resection for them at our institution between January 2005 and December 2016. We collected their clinicopathologic data to evaluate surgical outcomes. RESULTS The 13 patients comprised seven men and six women. Complete resection was performed in all cases. All the tumors were typical carcinoids, including one oncocytic carcinoid which showed highest fluorodeoxyglucose (FDG) uptake (SUVmax 45.7). The 5-year overall survival rates were 100%. The only patient with oncocytic carcinoid developed recurrence of liver metastasis 49 months after the primary lung resection. The metastasis showed low FDG uptake (SUVmax 2.8) and its histology was typical carcinoid and not oncocytic carcinoid. CONCLUSION Surgical outcomes in our patients were favorable. In oncocytic carcinoid, metastatic site may have a radiologic and histologic appearance different from the primary tumor.
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Affiliation(s)
- Tsuyoshi Ueno
- Department of Thoracic Surgery, National Hospital Organization, Shikoku Cancer Center, 160 Minami-Umemoto, Matsuyama, 791-0280, Japan.
| | - Yuho Maki
- Department of Thoracic Surgery, National Hospital Organization, Shikoku Cancer Center, 160 Minami-Umemoto, Matsuyama, 791-0280, Japan
| | - Ryujiro Sugimoto
- Department of Thoracic Surgery, National Hospital Organization, Shikoku Cancer Center, 160 Minami-Umemoto, Matsuyama, 791-0280, Japan
| | - Motohiro Yamashita
- Department of Thoracic Surgery, National Hospital Organization, Shikoku Cancer Center, 160 Minami-Umemoto, Matsuyama, 791-0280, Japan
| | - Kentaro Nakata
- Department of Thoracic Surgery, National Hospital Organization, Shikoku Cancer Center, 160 Minami-Umemoto, Matsuyama, 791-0280, Japan
| | - Yoshifumi Sugawara
- Department of Diagnostic Radiology, National Hospital Organization, Shikoku Cancer Center, Matsuyama, Japan
| | - Rieko Nishimura
- Department of Pathology, National Hospital Organization, Shikoku Cancer Center, Matsuyama, Japan
| | - Norihiro Teramoto
- Department of Pathology, National Hospital Organization, Shikoku Cancer Center, Matsuyama, Japan
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Appropriate surgical modalities for stages T2a and T2b in the eighth TNM classification of lung cancer. Sci Rep 2017; 7:13050. [PMID: 29026165 PMCID: PMC5638957 DOI: 10.1038/s41598-017-13495-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/26/2017] [Indexed: 12/25/2022] Open
Abstract
Patients with tumors of 3 to 5 cm were divided into stages T2a (3 to 4 cm) and T2b (4 to 5 cm) based on the 8th tumor-node-metastasis staging system for lung cancer. The objective of our study was to explore appropriate surgical modalities for the new stages, T2a and T2b. We selected 6,996 node-negative non-small-cell lung cancer patients with tumor sizes of 3 to 5 cm, diagnosed between 2009 and 2013, from the Surveillance, Epidemiology, and End Results (SEER) program. The Pearson \documentclass[12pt]{minimal}
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\begin{document}$${\chi }^{2}$$\end{document}χ2. statistic test and Kaplan–Meier curve were used to analyze patient data. The prognosis of patients with stage T2a was significantly better than that of patients with stage T2b, both in overall survival (p = 0.018) and lung cancer specific survival (p = 0.001). For patients with stage T2a, lobectomy had a significantly better outcome. For patients with stage T2b, surgical modalities including pneumonectomy, segmental resection and lobectomy, had similar outcomes in terms of survival. Consequently, lobectomy was the most appropriate surgical treatment modality for new stage T2a patients, whereas, for new T2b patients, treatment outcome did not vary significantly with the choice of surgical modality.
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14
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Ouede R, Masmoudi H, Etienne H, Assouad J. [Bronchial carcinoid tumor and recurrent pneumothoraxes]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:263-266. [PMID: 29031965 DOI: 10.1016/j.pneumo.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/01/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
Pneumothorax is a rare clinical manifestation of lung cancer. It can exceptionally reveal a bronchial carcinoid tumor. We present the case of a 27-year-old woman in whom recurrent pneumothoraxes were the clinical manifestation of a bronchial carcinoid tumor. The interest for chest computed tomography and bronchoscopy to identify etiology of secondary pneumothoraxes will be discussed.
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Affiliation(s)
- R Ouede
- Service de chirurgie thoracique, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - H Masmoudi
- Service de chirurgie thoracique, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - H Etienne
- Service de chirurgie thoracique, hôpital Tenon, 4, rue de Chine, 75020 Paris, France.
| | - J Assouad
- Service de chirurgie thoracique, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
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15
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Molecular Profiling and Survival of Completely Resected Primary Pulmonary Neuroendocrine Carcinoma. Clin Lung Cancer 2016; 18:e197-e201. [PMID: 28024928 DOI: 10.1016/j.cllc.2016.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/13/2016] [Accepted: 11/22/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Currently, molecular profiles and prognosis of primary pulmonary neuroendocrine carcinoma (PNC) are poorly elucidated. The present study was designed to evaluate genomic abnormalities and survival in patients with primary PNC. METHODS Completely resected PNC samples were collected from Zhejiang Cancer Hospital during the period of 2008 to 2015. Nine driver genes, including 6 mutations (EGFR, KRAS, NRAS, PIK3CA, BRAF, and HER2) and 3 fusions (ALK, ROS1, and RET), were evaluated by reverse transcription-polymerase chain reaction (RT-PCR). Survival analysis was conducted by the Kaplan-Meier method. RESULTS A total of 108 patients with pathologically confirmed PNC were enrolled. The types were pulmonary large-cell neuroendocrine carcinoma (PLCNC, n = 52), small-cell lung cancer (SCLC, n = 44), and carcinoid (n = 12). Twelve patients (11.1%) harbored genomic aberrations. The most frequent gene abnormalities in decreasing order were PIK3CA (n = 5, 4.6%), EGFR (n = 3, 2.8%), KRAS (n = 2, 1.9%), ALK (n = 1, 0.9%), and RET (n = 1, 0.9%). No ROS1, BRAF, NRAS, or HER2 mutation was detected. The frequencies of gene aberrations were 15.4%, 6.8%, and 8.3% in PLCNC, SCLC, and carcinoid, respectively. Survival differences existed among PLCNC, SCLC, and carcinoid groups (37.0 vs. 34.0 vs. not reached, P = .035); however, no difference existed between PLCNC and SCLC groups (P = .606). CONCLUSIONS Genomic abnormality is rare in patients with PNC and it is the most frequently observed in PLCNC.
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