全国性肺神经内分泌（类癌）肿瘤管理多中心研究。
Nationwide multicenter study on the management of pulmonary neuroendocrine (carcinoid) tumors.
作者信息
Sadowski Samira M, Christ Emanuel, Bédat Benoit, Kollár Attila, Karenovics Wolfram, Perren Aurel, Triponez Frédéric
机构信息
Thoracic and Endocrine SurgeryUniversity Hospitals of Geneva, Geneva, Switzerland
Department of EndocrinologyDiabetes and Metabolism, University Hospital of Basel, Basel, Switzerland.
出版信息
Endocr Connect. 2018 Jan;7(1):8-15. doi: 10.1530/EC-17-0271. Epub 2017 Dec 11.
BACKGROUND AND AIM
To analyze the management and outcome of patients with primary typical (TC) and atypical lung carcinoids (AC) in Switzerland.
METHODS
Retrospective analysis of patients selected from a neuroendocrine tumor (NET) registry. Patients were divided into TC and AC according to pathology reports, and surgical procedures were grouped as wedge/segmentectomy, lobectomy/bilobectomy and pneumectomy. Survival analysis was performed using the Kaplan-Meier method and log-rank test.
RESULTS
Over 7 years, 113 pulmonary carcinoids (61.9% females, mean age 59.4 years) were included from 19 hospitals, with pathology data on Ki67 and necrosis incomplete in 16 cases. Eighty-three TC and 14 AC underwent surgical resection with a primary tumor size of median 14.5 (range 1-80) mm and diagnosis was established in 55.8% at surgery. Mean follow-up was 30.2 ± 23.1 months. Lobectomy was performed in 54.2% and wedge resection in 17.7% of cases. Six patients received additional systemic therapy. There was a trend for larger primary lesion size and a significantly higher rate of N2-N3 status in AC. Mean survival tended to be increased in patients with TC compared to AC (86.1 vs 48.4 months, = 0.06) and mean disease-free interval after surgical resection was 74.1 and 48.3 months for TC and AC, respectively ( = 0.74).
CONCLUSION
AC of the lung has a more malignant behavior and a trend to a worse outcome. The results of this registry reinforce the need for standardized histological diagnosis and inter-disciplinary therapeutic decision making to improve the quality of care of patients with TC and AC.
背景与目的
分析瑞士原发性典型类癌（TC）和非典型类癌（AC）患者的治疗及预后情况。
方法
对从神经内分泌肿瘤（NET）登记处选取的患者进行回顾性分析。根据病理报告将患者分为TC和AC两组，手术方式分为楔形/肺段切除术、肺叶/双肺叶切除术及全肺切除术。采用Kaplan-Meier法和对数秩检验进行生存分析。
结果
7年间，从19家医院纳入了113例肺类癌患者（女性占61.9%，平均年龄59.4岁），16例患者的Ki67和坏死病理数据不完整。83例TC和14例AC接受了手术切除，原发肿瘤大小中位数为14.5（范围1-80）mm，55.8%的患者在手术时确诊。平均随访时间为30.2±23.1个月。肺叶切除术占54.2%，楔形切除术占17.7%。6例患者接受了额外的全身治疗。AC组原发灶尺寸有增大趋势，N2-N3状态发生率显著更高。TC患者的平均生存期相比AC组有延长趋势（86.1个月对48.4个月，P=0.06），TC和AC手术切除后的平均无病间期分别为74.1个月和48.3个月（P=0.74）。
结论
肺AC具有更恶性的行为及预后较差的趋势。该登记处的结果强化了标准化组织学诊断及跨学科治疗决策的必要性，以提高TC和AC患者的护理质量。
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