Oliaro A, Donati G, Filosso P L, Ruffini E
Dipartimento di Fisiopatologia Clinica, Università degli Studi, Torino.
Minerva Chir. 2000 Jan-Feb;55(1-2):7-16.
To review the patients treated at our Institute over the past 22 years and to evaluate the behaviour of 14 atypical carcinoids on the basis of Capella's classification (1994), defining the most suitable surgical approach.
A total of 118 patients undergoing surgery for lung neuroendocrine tumours were reanalyzed on the basis of their anatomic and pathological characteristics, surgical treatment and survival.
The 5-year survival rate was 96.5% for typical forms and 74.5% for atypical forms; the 10-year survival rate was 92.4% for typical forms and 49.8% for atypical forms (p < 0.001). Lymph node metastatic involvement was also an important contributing factor for survival (p < 0.05). A review of the series of 19 patients treated over the past 6 years, diagnosed with so-called atypical carcinoid based on Capella's anatomic and pathological classification, showed that 5 were well differentiated neuroendocrine tumours (WDNT), 8 well differentiated neuroendocrine carcinomas (WDNC) and 1 small-cell lung neuroendocrine carcinoma (SLCL). From a surgical point of view, 10 cases underwent demolitive surgery and 9 conservative surgery. The overall actuarial survival rate in this series was 78% at 5 years, 100% for WDNT and 75% for WDNC. The only case of SCLC died after a few months.
The authors conclude that the 5 and 10-year probability of survival are closely linked to the histological type of the lung neuroendocrine tumour and the presence of lymph node metastasis. Capella's new anatomic and pathological classification helps to establish a more precise prognosis for so-called atypical carcinoids. Lastly, given the malignant potential of these tumours, preference should be given to radical exeresis.
回顾我院过去22年治疗的患者，并根据卡佩拉分类法（1994年）评估14例非典型类癌的行为，确定最合适的手术方法。
根据118例接受肺神经内分泌肿瘤手术患者的解剖和病理特征、手术治疗及生存情况进行重新分析。
典型类型的5年生存率为96.5%，非典型类型为74.5%；典型类型的10年生存率为92.4%，非典型类型为49.8%（p<0.001）。淋巴结转移也是影响生存的重要因素（p<0.05）。回顾过去6年治疗的19例患者系列，根据卡佩拉的解剖和病理分类诊断为所谓的非典型类癌，结果显示5例为高分化神经内分泌肿瘤（WDNT），8例为高分化神经内分泌癌（WDNC），1例为小细胞肺神经内分泌癌（SLCL）。从手术角度来看，10例接受了根治性手术，9例接受了保守手术。该系列的总体精算生存率5年时为78%，WDNT为100%，WDNC为75%。唯一的SCLC病例在几个月后死亡。
作者得出结论，5年和10年生存率与肺神经内分泌肿瘤的组织学类型及淋巴结转移密切相关。卡佩拉新的解剖和病理分类有助于为所谓的非典型类癌建立更准确的预后。最后，鉴于这些肿瘤的恶性潜能，应优先选择根治性切除。
