Department of Thoracic Surgery, Shanghai Chest Hospital affiliated to Shanghai Jiao Tong University, Shanghai 200030, China.
Chin Med J (Engl). 2012 Sep;125(17):3022-6.
Bronchial carcinoids are rare malignant neuroendocrine neoplasms. Some issues regarding surgical treatment of bronchial carcinoids remain controversial, including the role of bronchoplastic surgery and necessity of systematic lymphadenectomy.
This retrospective study involved 131 consecutive patients surgically treated for carcinoid tumors at Shanghai Chest Hospital between March 1990 and August 2010.
Eighty-nine (67.9%) of the patients were male, and the mean age was 46 years, ranging from 17 to 81 years. Preoperative fiberoptic bronchoscopy was performed in all patients. Endoscopic biopsy was performed in 100 patients with central tumors, and 70 (70%) patients were diagnosed as bronchial carcinoid. The resections performed consisted of 31 pneumonectomie, 32 lobectomies, 26 bilobectomies, 34 sleeve lobectomies, six bronchoplastic procedures without lung resection, and two segmentectomies. During a median of 87 months follow-up, there were nine recurrences including three local recurrences and 6 distant recurrences. No bronchial recurrences were observed. The 3-, 5- and 10-year overall survival rates of pneumonectom and bronchoplastic surgery (including sleeve lobectomy and bronchoplastic procedure without lung resection) were 93.2%, 81.0% and 69.4%, 97.5%, 91.9% and 70.0%, respectively. Multivariate Cox regression indicated that histology and nodal status were significant independent prognostic factors.
Bronchoplastic surgery should be considered whenever possible for central carcinoids. Systematic lymphadenectomy is recommended for bronchial carcinoid patients. Histology and nodal status were significant independent prognostic factors of overall survival of patients with bronchial carcinoid.
支气管类癌是罕见的恶性神经内分泌肿瘤。一些关于支气管类癌的外科治疗的问题仍然存在争议，包括支气管成形术的作用和系统性淋巴结清扫的必要性。
本回顾性研究纳入了 1990 年 3 月至 2010 年 8 月期间在上海胸科医院接受手术治疗的 131 例类癌肿瘤患者。
89 例（67.9%）患者为男性，平均年龄为 46 岁，年龄 17 至 81 岁。所有患者均行术前纤维支气管镜检查。100 例中央型肿瘤患者行内镜活检，70 例（70%）诊断为支气管类癌。行 31 例全肺切除术、32 例肺叶切除术、26 例双肺叶切除术、34 例袖状肺叶切除术、6 例非肺切除的支气管成形术和 2 例节段切除术。中位随访 87 个月，9 例患者复发，包括 3 例局部复发和 6 例远处复发。未观察到支气管复发。全肺切除和支气管成形术（包括袖状肺叶切除术和非肺切除的支气管成形术）的 3 年、5 年和 10 年总生存率分别为 93.2%、81.0%和 69.4%，97.5%、91.9%和 70.0%。多因素 Cox 回归分析表明，组织学和淋巴结状态是显著的独立预后因素。
对于中央型类癌，应尽可能考虑支气管成形术。支气管类癌患者建议行系统性淋巴结清扫。组织学和淋巴结状态是支气管类癌患者总生存率的显著独立预后因素。
