Rubino M, Scoazec J Y, Pisa E, Faron M, Spaggiari L, Hadoux J, Spada F, Planchard D, Cella C A, Leboulleux S, De Marinis F, Ducreux M, Lamartina L, Baudin E, Fazio N
Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy; Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Université Paris Saclay, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
Department of Pathology and Laboratory Medicine, Gustave Roussy and Paris Saclay University, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
Lung Cancer. 2020 Oct;148:149-158. doi: 10.1016/j.lungcan.2020.08.001. Epub 2020 Aug 8.
Highly proliferative lung carcinoids (HPLC) have been recently reported but information about this subset remains scarce.
Clinical and pathological data of 630 patients with lung carcinoids (LC) referred to Gustave Roussy Institute (GR) and European Institute of Oncology (IEO) were retrospectively reviewed to select HPLC and analyze their frequency, behavior and compare their outcome to conventional LC with Ki-67 ≤ 20 % and mitotic count (MC)≤10/2 mm.
Selection criteria were: diagnosis of LC confirmed by local pathologist, and available clinical and follow-up data. Patients with Ki-67 > 20 % and/or MC > 10/ 2 mm2 in primary or metastatic specimens were identified as HPLC.
30/514 patients (6%) met the selection criteria of HPLC. Based on primary tumor evaluation, 22/25 (88 %) were classified as atypical carcinoids (AC). Median MC was 4.5/2 mm (1-11) 6/2 mm (3-15) in primary tumors and metastasis, respectively. Median Ki-67 was respectively 23 % (15-65) and 25 % (8-60). Recurrence rate was 66 % (12/18) in HPLC and 9 % (33/352) in conventional LC. Median RFS was 24 (10-NR) months in HPLC, 288 (141-NR) months in LC with Ki-67 index≤5 % and NR (148-NR) months in LC with Ki-67 6-20% (p < 001). Median OS was 203 (83-NR) months in LC with Ki-67 index≤5%, 101 (79-NR) months in LC with Ki-67 index 6-20 % and 53 (39-NR) months in HPLC (p = 002). Among 20 metastatic patients with HPLC, median PFS under platinum-based chemotherapy, everolimus, alkylating-based chemotherapy, FOLFOX and PRRT was 5.1 (95 % CI 0.7-9.4), 12.1(95 %CI 0.3-24), 6.8 (95 % CI 0-14.9), 10.2 (95 % CI 0.4-19.9) and 14.2 months (95 % CI 0-30) respectively. Best response was stable disease (SD) under platinum-based chemotherapy and partial response (PR) under alkylating-based chemotherapy and FOLFOX.
This study confirms the existence and rarity of HPLC. Their characteristics and clinical behavior are more similar to LC rather than neuroendocrine carcinomas (NECs), suggesting that this entity could be managed accordingly.
最近有关于高增殖性肺类癌（HPLC）的报道，但关于这一亚组的信息仍然很少。
回顾性分析转诊至古斯塔夫·鲁西研究所（GR）和欧洲肿瘤研究所（IEO）的630例肺类癌（LC）患者的临床和病理数据，以筛选出HPLC，并分析其频率、行为，并将其结果与Ki-67≤20%且有丝分裂计数（MC）≤10/2mm的传统LC进行比较。
选择标准为：经当地病理学家确诊为LC，且有可用的临床和随访数据。在原发性或转移性标本中，Ki-67>20%和/或MC>10/2mm²的患者被确定为HPLC。
30/514例患者（6%）符合HPLC的选择标准。根据原发性肿瘤评估，22/25例（88%）被分类为非典型类癌（AC）。原发性肿瘤和转移灶的中位MC分别为4.5/2mm（1-11）和6/2mm（3-15）。中位Ki-67分别为23%（15-65）和25%（8-60）。HPLC的复发率为66%（12/18），传统LC的复发率为9%（33/352）。HPLC的中位无复发生存期（RFS）为24（10-未达到）个月，Ki-67指数≤5%的LC为288（141-未达到）个月，Ki-67为6-20%的LC为未达到（148-未达到）个月（p<0.001）。Ki-
