Forde Patrick M, Hooker Craig M, Boikos Sosipatros A, Petrini Iacope, Giaccone Giuseppe, Rudin Charles M, Yang Stephen C, Illei Peter B, Hann Christine L, Ettinger David S, Brahmer Julie R, Kelly Ronan J
Departments of *Medical Oncology, †Surgery, and ‡Pathology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; and §Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland.
J Thorac Oncol. 2014 Mar;9(3):414-8. doi: 10.1097/JTO.0000000000000065.
Data to guide the management of advanced pulmonary carcinoid (APC) come from retrospective reports and subgroup analyses of trials that included mainly extrapulmonary carcinoid tumors. We report the largest series to date of 49 patients with locally advanced or metastatic pulmonary carcinoid.
The Johns Hopkins Pathology Database was reviewed for APC patients treated between January 1992 and December 2012. Data on time to recurrence, progression-free survival, and overall survival were estimated by using the Kaplan-Meier method.
Forty-nine patients were treated for APC in the specified time period. Median time to recurrence after surgical resection was 2.5 years (atypical carcinoid [AC] versus typical carcinoid [TC], 2.5 versus 6.3 years; p = 0.063). Median survival with advanced disease was 7.1 years and significantly longer for TC compared with AC (10.2 versus 4 years; p = 0.009). Among the diverse systemic therapies used, responses occurred in four of 17 patients (23.5%) who received platinum/etoposide with a median progression-free survival of 7 months.
Although systemic chemotherapy has moderate activity for APC, novel approaches are required. TC and AC, although both classified as pulmonary carcinoid, are clearly different clinical and molecular entities and require separate treatment paradigms in the advanced/metastatic setting.
指导晚期肺类癌（APC）治疗的数据来自回顾性报告以及主要纳入肺外类癌肿瘤的试验的亚组分析。我们报告了迄今为止最大的一组49例局部晚期或转移性肺类癌患者。
回顾约翰霍普金斯病理数据库中1992年1月至2012年12月期间接受治疗的APC患者。采用Kaplan-Meier方法估计复发时间、无进展生存期和总生存期的数据。
在指定时间段内，49例患者接受了APC治疗。手术切除后的中位复发时间为2.5年（非典型类癌[AC]与典型类癌[TC]，分别为2.5年和6.3年；p = 0.063）。晚期疾病的中位生存期为7.1年，TC患者明显长于AC患者（分别为10.2年和4年；p = 0.009）。在使用的各种全身治疗中，17例接受铂/依托泊苷治疗的患者中有4例（23.5%）有反应，中位无进展生存期为7个月。
尽管全身化疗对APC有中等活性，但仍需要新的治疗方法。TC和AC虽然都归类为肺类癌，但显然是不同的临床和分子实体，在晚期/转移性情况下需要不同的治疗模式。
