Department of Lung Cancer Surgery.
Tianjin key laboratory of lung cancer metastasis and tumor microenvironment, Lung Cancer Institute,Tianjin Medical University General Hospital, Tianjin, China.
Ann Surg. 2022 Dec 1;276(6):e991-e999. doi: 10.1097/SLA.0000000000004593. Epub 2020 Nov 13.
This study aimed to determine the optimal surgical procedure for early-stage pulmonary carcinoids (PCs).
PCs, comprising typical carcinoids (TCs) and atypical carcinoids (ACs), are rare low-grade malignant tumors. We determine the optimal surgical management for early-stage PCs using data from the Surveillance, Epidemiology, and End Results registry.
Clinical and survival data of patients with early-stage PC tumors with a diameter ≤3 cm were retrieved. The Kaplan-Meier method and logrank tests were used to assess the differences in overall survival (OS). Subgroup analyses were also performed. To reduce the inherent bias of retrospective studies, two propensity score matching (PSM) analysis with (PSM2) or without (PSM1) consideration of lymph node assessment were performed.
In total, 2934 patients with PCs, including 2741 (93.42%) with TCs and 193 (6.58%) with ACs, were recruited. After PSM1 analysis, TC patients in the lobectomy group had a significantly better OS than those in the sublobar resection group ( P = 0.0067), which is more remarkable for patients with a tumor diameter of 2 cm <T ≤ 3 cm ( P = 0.0345) and those aged <70 years ( P = 0.0032). However, survival benefits were not found after PSM2 analysis which balanced lymph node assessment. In multivariate cox analysis, age <70 years, female, TC histology and adequate lymph node assessment were associated with better OS.
Sublobar resection may not significantly compromise the longterm oncological outcomes in early-stage PCs ≤3 cm in size if lymph node assessment is performed adequately. Further validation in large randomized clinical trials is warranted.
本研究旨在确定早期肺类癌（PCs）的最佳手术方法。
PCs 包括典型类癌（TCs）和非典型类癌（ACs），是罕见的低级别恶性肿瘤。我们使用监测、流行病学和最终结果（SEER）登记处的数据确定早期 PCs 的最佳手术管理。
检索了直径≤3cm 的早期 PC 肿瘤患者的临床和生存数据。使用 Kaplan-Meier 方法和对数秩检验评估总生存（OS）的差异。还进行了亚组分析。为了减少回顾性研究的固有偏差，进行了两次倾向评分匹配（PSM）分析，一次考虑（PSM2），一次不考虑（PSM1）淋巴结评估。
共纳入 2934 例 PCs 患者，其中 2741 例（93.42%）为 TCs，193 例（6.58%）为 ACs。在 PSM1 分析后，肺叶切除术组 TC 患者的 OS 明显优于亚肺叶切除术组（P=0.0067），对于肿瘤直径为 2cm<T≤3cm 的患者（P=0.0345）和年龄<70 岁的患者（P=0.0032）更为显著。然而，在平衡淋巴结评估的 PSM2 分析后，未发现生存获益。多因素 Cox 分析显示，年龄<70 岁、女性、TC 组织学和充分的淋巴结评估与更好的 OS 相关。
如果充分进行淋巴结评估，亚肺叶切除术可能不会显著影响直径≤3cm 的早期 PCs 的长期肿瘤学结果。需要在大型随机临床试验中进一步验证。
