Kyriss Thomas, Maier Sibylle, Veit Stefanie, Fritz Peter, Toomes Heikki, Friedel Godehard
Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Gerlingen, Germany.
Thorac Surg Sci. 2006 Sep 4;3:Doc03.
Carcinoids are rare neuroendocrine tumors of the bronchial system. Only recently, the histological classification was standardized, and there are varying opinions about the extent of surgical resection. This research reports on the long-term results of 111 consecutive patients, who underwent surgery in a department for thoracic surgery.
Between 1/1988 and 2/2001, 111 consecutive pulmonary resections were conducted in patients with bronchial carcinoids. Retrospectively, researchers obtained clinical and surgical data and re-classified all histological specimen according to the WHO classification of 1999. Information regarding long-term results was obtained by using data obtained during follow-up visits and by talking to the patient on the phone.
97 patients with typical and 14 with atypical carcinoids were identified. The preoperative diagnosis of typical or atypical carcinoid had been correct in 56 patients (50.5%). Surgical procedures included 79 lobectomies, 16 bilobectomies, 8 pneumonectomies, 5 segmental resections, 2 sleeve resections of the main bronchus without parenchymal resection and one exploratory thoracotomy. Mediastinal lymphadenectomies were performed on 105 patients (94.6%). Postoperative staging revealed 91 patients (81.2%) in UICC stage I, 12 (10.8%) in stage II, 7 in stage III and one in stage IV. 97 (87.4%) typical and 14 (12.6%) atypical carcinoids were classified. 30-day mortality was 1.8% (n=2). Mean follow-up was 73.4 months. The total cohort showed a 5-year survival rate of 94% and a 10-year survival rate of 82%. In patients with typical and atypical carcinoids, the 5-year survival rates were 94% and 82%, respectively (n.s.), and the 10-year survival rates were 92% and 62%, respectively (p<0.01). The 5- (10-) year survival rate without lymph node involvement was 96% (85%), with N1 involvement 88% (65%), with N2 involvement 67% (no 10-year survival).
Patients with bronchial carcinoids who underwent a radical oncological resection with mediastinal lymphadenectomy have very good survival chances. There are no prospective randomized studies evaluating the surgical procedures as they relate to the classification. Since a preoperative diagnosis cannot clearly determine if the lymph nodes are involved and what histology type the physician dealing with, a limited resections without lymphadenectomy is insufficient. It is absolutely necessary to conduct retrospective and multi-center studies on the prognostic importance of lymph node involvement and on the impact of adjuvant therapies.
类癌是支气管系统罕见的神经内分泌肿瘤。直到最近，其组织学分类才得以标准化，关于手术切除范围也存在不同观点。本研究报告了111例在胸外科接受手术的连续患者的长期结果。
1988年1月至2001年2月期间，对111例支气管类癌患者进行了连续的肺切除术。研究人员回顾性地获取了临床和手术数据，并根据1999年世界卫生组织分类对所有组织学标本进行了重新分类。通过随访期间获得的数据以及与患者电话沟通获取了长期结果的信息。
确定了97例典型类癌和14例非典型类癌患者。术前对典型或非典型类癌的诊断在56例患者（50.5%）中是正确的。手术方式包括79例肺叶切除术、16例双肺叶切除术、8例全肺切除术、5例肺段切除术、2例主支气管袖状切除术（无实质切除）和1例开胸探查术。105例患者（94.6%）进行了纵隔淋巴结清扫术。术后分期显示，91例患者（81.2%）处于UICC I期，12例（10.8%）处于II期，7例处于III期，1例处于IV期。97例（87.4%）典型类癌和14例（12.6%）非典型类癌进行了分类。30天死亡率为1.8%（n = 2）。平均随访时间为73.4个月。整个队列的5年生存率为94%，10年生存率为82%。典型类癌和非典型类癌患者的5年生存率分别为94%和82%（无统计学差异），10年生存率分别为92%和62%（p < 0.01）。无淋巴结受累的5年（10年）生存率为96%（85%），N1受累为88%（65%），N2受累为67%（无10年生存者）。
接受根治性肿瘤切除及纵隔淋巴结清扫术的支气管类癌患者有非常好的生存机会。目前尚无前瞻性随机研究评估与分类相关的手术方式。由于术前诊断无法明确确定淋巴结是否受累以及所处理的组织学类型，因此不进行淋巴结清扫的有限切除是不够的。绝对有必要对淋巴结受累的预后重要性以及辅助治疗的影响进行回顾性和多中心研究。
