肺类癌的外科切除：多中心研究的长期结果-病理 N 状态的重要性，超乎我们想象。
Surgical Resection for Pulmonary Carcinoid: Long-Term Results of Multicentric Study-The Importance of Pathological N Status, More Than We Thought.
机构信息
General Thoracic Surgery, "Vittorio Emanuele-Policlinico" Hospital , Catania, Italy.
Department of Thoracic Surgery, Cochin Hospital, AP-HP, Paris, France.
出版信息
Lung. 2017 Dec;195(6):789-798. doi: 10.1007/s00408-017-0056-8. Epub 2017 Oct 11.
BACKGROUND
Histological subdivision into typical (TC) and atypical (AC) is crucial for treatment and prognosis of lung carcinoids but can be also very challenging, even for experts. In this study, we aimed to strengthen or reduce the prognostic value of several pathological, clinical, or per-operative factors some of which are still controversial.
METHODS
We retrospectively reviewed clinical records related to 195 patients affected by TC (159) or AC (36) surgically treated between 2000 and 2014, in three different centers. Survival and subtypes comparison analyses were performed to identify potential prognostic factors.
RESULTS
TCs showed a lower rate of nodal involvement than ACs (N0 = 94.9%; N1 = 1.9%; N2 = 3.2% in typical and N0 = 63.8%; N1 = 16.6%; N2 = 19.4% in atypical carcinoids, respectively, p < 0.0001). Long-term oncological results of resected carcinoids were significantly better in TCs than ACs with higher 5- and 10-year overall survival rates (97.2 and 88.2% vs. 77.9 and 68.2%, respectively; p = 0.001) and disease-free survival rates (98.2 and 90.3% in typical and 80.8 and 70.7% atypical carcinoids, respectively; p = 0.001). Risk factors analysis revealed that AC subtype [HR 4.33 (95% CI 1.72-8.03), p = 0.002], pathological nodal involvement [HR 3.05 (95% CI 1.77-5.26), p < 0.0001], and higher SUV [HR 4.33 (95% CI 1.03-7.18), p = 0.002] were independently and pejoratively associated with overall survival. Factors associated with a higher risk of recurrence were AC subtype [HR 6.13 (95% CI 1.13-18.86), p = 0.002]; nodal involvement [HR 5.48 (95% CI 2.85-10.51), p < 0.0001]; higher Ki67 expression level [HR 1.09 (95% CI 1.01-1.20), p = 0.047]; and SUV [HR 1.83 (95% CI 1.04-3.23), p = 0.035].
CONCLUSION
Surgery for lung carcinoids allows satisfactory oncological results which mainly depend on carcinoid subtype dichotomy, pathological nodal status, and SUV.
背景
肺类癌的组织学细分（典型 TC 和非典型 AC）对治疗和预后至关重要，但即使对于专家来说也极具挑战性。本研究旨在增强或降低一些病理、临床或手术相关因素的预后价值，其中一些因素仍存在争议。
方法
我们回顾性分析了 2000 年至 2014 年间在三个不同中心接受手术治疗的 195 例典型 TC（159 例）或非典型 AC（36 例）患者的临床记录。通过生存和亚型比较分析来确定潜在的预后因素。
结果
TC 的淋巴结受累率低于 AC（典型为 N0=94.9%；N1=1.9%；N2=3.2%，非典型为 N0=63.8%；N1=16.6%；N2=19.4%，p<0.0001）。与 AC 相比，TC 的长期肿瘤学结果明显更好，5 年和 10 年总生存率（分别为 97.2%和 88.2%比 77.9%和 68.2%；p=0.001）和无病生存率（分别为 98.2%和 90.3%比 80.8%和 70.7%；p=0.001）更高。风险因素分析显示，AC 亚型[HR 4.33（95%CI 1.72-8.03），p=0.002]、病理淋巴结受累[HR 3.05（95%CI 1.77-5.26），p<0.0001]和更高的 SUV[HR 4.33（95%CI 1.03-7.18），p=0.002]与总生存率独立且呈负相关。与复发风险较高相关的因素包括 AC 亚型[HR 6.13（95%CI 1.13-18.86），p=0.002]；淋巴结受累[HR 5.48（95%CI 2.85-10.51），p<0.0001]；Ki67 高表达水平[HR 1.09（95%CI 1.01-1.20），p=0.047]和 SUV[HR 1.83（95%CI 1.04-3.23），p=0.035]。
结论
肺类癌的手术治疗可获得满意的肿瘤学结果，主要取决于类癌的亚型、病理淋巴结状态和 SUV。
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