Predictive Indicators of Survival in Patients With Surgically Resected Lung Carcinoid Tumors at a Greek Medical Center

Clinicopathological, Oncogenic, and 18F-FDG PET/CT Features of Primary Pulmonary Carcinoid in Resection Specimens

Objectives

The metabolic parameters which included mean standardised uptake value (SUVmean), metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardised uptake lean body mass (SULmax), and maximum standardised uptake body surface area (SUVbsa) have rarely been investigated in pulmonary carcinoid (PC). This study aimed to retrospectively compare the ¹⁸F-FDG PET/CT features of PC subtypes and observe clinicopathological and oncogenic characteristics of PC.

Methods

We performed a retrospective review in 60 patients with PC, from January 2016 to November 2021, who underwent the ¹⁸F-FDG PET/CT scan. All the PC diagnoses were histopathologic confirmed by surgical samples. The metabolic and morphological features were obtained from ¹⁸F-FDG PET/CT images. The ratio of metabolic to morphological lesion volumes (MMVR) was calculated.

Results

Sixty patients with PC were consecutively identified, including 39 patients (65.0%) with typical carcinoids (TCs) and 21 (35.0%) with atypical carcinoids (ACs). One (1/21) patient had mutation in BRAF. The ACs have a larger size (P < 0.001), more metastatic lymph nodes (P = 0.011), higher Ki-67 expression (P < 0.001), higher SUVmax values (P = 0.003), higher SUVmean values (P = 0.006), higher SULmax values (P = 0.005), higher SUVbsa values (P = 0.001), higher MTV values (P = 0.033), and higher TLG values (P = 0.002). The multivariate analysis showed that MMVR (P = 0.020) was significantly associated with AC. For predicting AC, the optimal cut-off value of SUVmax, SUVmean, SULmax, SUVbsa, MTV, TLG, and the maximum diameter was 5.19, 3.18, 2.65, 1.47, 4.36, 18.44, and 3.0, respectively. The AUC values of above mentioned parameters was 0.756 (95%CI, 0.631–881; P = 0.001), 0.735 (95%CI, 0.602–868; P = 0.003), 0.736 (95%CI, 0.607–865; P = 0.003), 0.742 (95%CI, 0.612–873; P = 0.002), 0.593 (95%CI, 0.430–755; P = 0.239), 0.680 (95%CI, 0.531–829; P = 0.022), and 0.733 (95%CI, 0.598–868; P = 0.003), respectively. For predicting TC, the optimal cut-off value of the MMVR was 0.92, and the AUC value was 0.780 (95%CI, 0.647–0.913; P < 0.001).

Conclusion

¹⁸F-FDG PET/CT can simultaneously reveal the metabolic and morphological characteristics of PC, which is important in the differentiation for histopathologic subtypes.

Prognostic significance of laterality in lung neuroendocrine tumors

PURPOSE

Well-differentiated lung neuroendocrine tumors (Lu-NET) are classified as typical (TC) and atypical (AC) carcinoids, based on mitotic counts and necrosis. However, prognostic factors, other than tumor node metastasis (TNM) stage and the histopathological diagnosis, are still lacking. The current study is aimed to identify potential prognostic factors to better stratify lung NET, thus, improving patients' treatment strategy and follow-up.

METHODS

A multicentric retrospective study, including 300 Lung NET, all surgically removed, from Italian and Spanish Institutions.

RESULTS

Median age 61 years (13-86), 37.7% were males, 25.0% were AC, 42.0% were located in the lung left parenchyma, 80.3% presented a TNM stage I-II. Mitotic count was ≥2 per 10 high-power field (HPF) in 24.7%, necrosis in 13.0%. Median overall survival (OS) was 46.1 months (0.6-323), median progression-free survival (PFS) was 36.0 months (0.3-323). Female sex correlated with a more indolent disease (T1; N0; lower Ki67; lower mitotic count and the absence of necrosis). Left-sided primary tumors were associated with higher mitotic count and necrosis. At Cox-multivariate regression model, age, left-sided tumors, nodal (N) positive status and the diagnosis of AC resulted independent negative prognostic factors for PFS and OS.

CONCLUSIONS

This study highlights that laterality is an independent prognostic factors in Lu-NETs, with left tumors being less frequent but showing a worse prognosis than right ones. A wider spectrum of clinical and pathological prognostic factors, including TNM stage, age and laterality is suggested. These parameters could help clinicians to personalize the management of Lu-NET.

SURGICAL APPROACH OF LUNG CARCINOID TUMORS

Bronchial carcinoid tumours (typical and atypical carcinoid) are endobronchial tumours that can benefit from both local endobronchial treatment and surgical treatment. Given their relatively good prognosis compared to the other two forms of pulmonary neuroendocrine tumours, there is a current concern about the implications of lymph node involvement as well as the identification of new prognostic factors to shape the treatment of these patients in the future.

Prognostic value of the immunohistochemistry markers CD56, TTF-1, synaptophysin, CEA, EMA and NSE in surgically resected lung carcinoid tumors

Lung carcinoid tumor is a type of neuroendocrine tumor, which is subdivided into typical carcinoid (TC) and atypical carcinoid (AT), based on the rate of mitosis and the presence of necrosis. Several prognostic factors for lung carcinoids have been reported in the literature, including the type, Ki67 index, stage, chemotherapy and radiation therapy. In the present study, 108 cases with resected carcinoid lung tumors were enrolled and the expression of CD56, thyroid transcription factor 1, synaptophysin, carcinoembryonic antigen, epithelial membrane antigen and neuron-specific enolase (NSE) in the resected tissue specimens was immunohistochemically analyzed. Patients with positive staining for NSE had an unfavorable survival prognosis compared with patients with negative staining for NSE (137.2 vs. 150.0 months, P=0.044). According to univariate analysis, none of the above immunohistochemistry markers was associated with survival, and according to multivariate analysis, NSE was an independent influencing factor for survival inpatients with AT (P=0.046) and furthermore, the stage was an independent factor of survival in patients with TC (P=0.005).

Prognostic nomogram for predicting long-term survival in bronchopulmonary carcinoid tumor patients receiving resection

Background

We analyzed bronchopulmonary carcinoid tumor (BPC) patients receiving resection from the Surveillance, Epidemiology, and End Results (SEER) database to identify the predictive factors of their survival. Then, we developed and validated nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in BPC patients.

Methods

BPC patients registered in the SEER database were included. They were divided into a training set and an internal validation set (7:3). BPC patients from our center were included as an external validation set. Independent prognostic factors identified by a Cox regression model in the training set were used to construct nomograms to predict survival. Discrimination and calibration plots were used to evaluate the predictive accuracy of the nomograms. The nomograms were evaluated in both the internal and the external validation datasets.

Results

Age, pathological type, and N stage were identified as independent prognostic factors of OS and CSS by Cox analyses (all P<0.05). Tumor size ≥2.5 cm (P=0.045) was an independent factor for unfavorable CSS. Based on these variables, nomograms were constructed. All concordance indexes of the training set, internal validation set, and external validation set indicated that the nomograms had the preferable discriminatory ability. The calibration plots for predictions of the 1-, 3-, and 5-year OS and CSS were in excellent agreement.

Conclusions

Age, pathological type, N stage, and tumor size were independent predictive factors of prognosis in BPC patients receiving resection. These nomograms could serve as effective and accurate tools for the prognostic evaluation of patients with BPCs.