Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York.
Ann Thorac Surg. 2018 Oct;106(4):981-988. doi: 10.1016/j.athoracsur.2018.05.044. Epub 2018 Jun 15.
Pulmonary carcinoid tumors are often considered indolent tumors. The prognostic significance of lymph node (LN) metastases and the need for mediastinal dissection is controversial. We sought to determine the incidence, risk factors, and prognosis of LN metastases in resected carcinoid patients.
Patients undergoing lung resection for carcinoid and removal of ≥10 LNs were identified in the National Cancer Database from 2004 to 2014. Typical (TCs) and atypical carcinoids (ACs) were included. Clinical and pathologic LN status was assessed. Overall survival (OS) was analyzed using log-rank test and Cox hazard regression analysis.
A total of 3,335 patients (TC 2,893; AC 442), underwent resection (lobectomy/bilobectomy 84%, pneumonectomy 8%, sublobar resection 8%). LN involvement was present in 21% of patients (N1 15%, N2 6%) and increased with tumor size and AC histology. Tumor size was an independent predictor of LN disease. The rate of nodal upstaging was 13% (TC 11%, AC 24%). Independent predictors of OS were AC type (HR 3.25 [95% CI 2.19-4.78]) and LN metastases (HR 2.3 [1.49-3.58]). LN disease was associated with worse survival for TC > 2 cm (5-year OS 87% versus 94%, p = 0.005) and AC (58% versus 88%, p = 0.001), but not for small (≤ 2 cm) TC patients (5-year OS 93% versus 92%, p = 0.67).
A substantial number of well-staged carcinoid patients had LN metastases. Large tumor size is a valuable predictor of carcinoid nodal disease. LN involvement was an independent predictor of worse survival. Nodal dissection in tumors > 2 cm and in atypical subtype can yield important prognostic information.
肺类癌肿瘤通常被认为是惰性肿瘤。淋巴结（LN）转移的预后意义和纵隔清扫的必要性存在争议。我们旨在确定切除类癌患者的 LN 转移发生率、风险因素和预后。
从 2004 年至 2014 年，国家癌症数据库中确定了接受肺切除术治疗类癌并切除≥10 个淋巴结的患者。包括典型（TCs）和非典型类癌（ACs）。评估了临床和病理 LN 状态。使用对数秩检验和 Cox 风险回归分析来分析总生存率（OS）。
共有 3335 名患者（TC2893 例，AC442 例）接受了切除术（肺叶切除术/双肺叶切除术 84%，肺切除术 8%，亚肺叶切除术 8%）。21%的患者存在 LN 受累（N1 为 15%，N2 为 6%），且随着肿瘤大小和 AC 组织学的增加而增加。肿瘤大小是 LN 疾病的独立预测因素。淋巴结升级的发生率为 13%（TC11%，AC24%）。OS 的独立预测因素为 AC 类型（HR3.25[95%CI2.19-4.78]）和 LN 转移（HR2.3[1.49-3.58]）。对于 TC>2cm（5 年 OS 为 87%对 94%，p=0.005）和 AC（5 年 OS 为 58%对 88%，p=0.001）患者，LN 疾病与生存率降低相关，但对于小肿瘤（≤2cm）TC 患者，5 年 OS 为 93%对 92%，p=0.67）。
大量分期良好的类癌患者存在 LN 转移。大肿瘤大小是预测类癌淋巴结疾病的有价值的指标。LN 受累是生存率降低的独立预测因素。在>2cm 的肿瘤和非典型亚型中进行淋巴结清扫可以提供重要的预后信息。
