Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Ann Thorac Surg. 2011 Nov;92(5):1774-8; discussion 1778-9. doi: 10.1016/j.athoracsur.2010.08.080. Epub 2011 Jun 24.
The existing guidelines for extent of resection of carcinoid tumors are based on other, more malignant non-small cell lung cancers. Because of the small number of patients in any single institution, we analyzed the Surveillance Epidemiology and End Results (SEER) database to study the effect of the extent of resection of these tumors on overall survival.
All patients with lung cancer in the SEER database from 1973 to 2006 with carcinoid tumors as their only cancer were included. Variables examined included age, race (white, black, others), gender, histologic type (atypical versus typical carcinoid), stage (localized, regional, and distant), extent of resection (sublobar resection, lobectomy, or more extensive) and survival. Univariate analyses (Kaplan-Meier method) were used to select variables for multivariate analysis (Cox regression analysis). Associations were considered significant with an alpha error < 5%. In addition, propensity score-matched Cox regression analysis was performed for patients with typical carcinoid disease.
Most patients with carcinoid tumors did not acquire any other cancers (4,785/6,819; 70.2%). Of these, 797 patients had sublobar resection and 2,681 patients had lobectomy or more extensive resections. On univariate analysis, gender (p = 0.014), race (p < 0.001), stage (p < 0.001), histologic type (p < 0.001) and extent of resection (p = 0.04) were associated with overall survival. Multivariate analysis demonstrated that age, gender, race, stage, and histologic type remain statistically associated with overall survival and disease-specific survival, whereas extent of resection is not. Propensity score-matched analysis demonstrates that for typical carcinoid, extent of resection is not associated with overall survival when adjusted for age, gender, race, and stage.
Sublobar resection of carcinoid tumors did not compromise oncologic outcomes in a large population-based database. Lobectomy for typical carcinoid tumors is not mandatory as long as complete resection and adequate mediastinal staging are performed.
现有的类癌肿瘤切除术范围指南是基于其他更恶性的非小细胞肺癌制定的。由于每个医疗机构的患者数量较少，我们分析了监测、流行病学和最终结果（SEER）数据库，以研究这些肿瘤切除术范围对总生存的影响。
纳入 1973 年至 2006 年 SEER 数据库中所有肺癌患者，且唯一癌症为类癌肿瘤。检查的变量包括年龄、种族（白人、黑人、其他）、性别、组织学类型（非典型与典型类癌）、分期（局部、区域和远处）、切除术范围（亚肺叶切除术、肺叶切除术或更广泛的切除术）和生存。采用单变量分析（Kaplan-Meier 法）选择多变量分析（Cox 回归分析）的变量。关联具有统计学意义的临界值为 alpha 误差<5%。此外，对典型类癌疾病患者进行倾向评分匹配 Cox 回归分析。
大多数类癌肿瘤患者未发生其他任何癌症（4785/6819；70.2%）。其中，797 例患者行亚肺叶切除术，2681 例患者行肺叶切除术或更广泛的切除术。单变量分析显示，性别（p=0.014）、种族（p<0.001）、分期（p<0.001）、组织学类型（p<0.001）和切除术范围（p=0.04）与总生存相关。多变量分析表明，年龄、性别、种族、分期和组织学类型与总生存和疾病特异性生存仍具有统计学相关性，而切除术范围则没有。倾向评分匹配分析表明，对于典型类癌，在调整年龄、性别、种族和分期后，切除术范围与总生存无关。
在大型基于人群的数据库中，亚肺叶切除术并未影响类癌肿瘤的肿瘤学结果。只要进行完全切除和充分的纵隔分期，对于典型类癌肿瘤，行肺叶切除术并非必需。
