Thoracic Surgery Department, Álvaro Cunqueiro Hospital, Vigo, Spain.
Thoracic Surgery Department, University Hospital, Valladolid, Spain.
Interact Cardiovasc Thorac Surg. 2021 May 27;32(6):904-910. doi: 10.1093/icvts/ivab026.
Atypical carcinoids are neuroendocrine neoplasms of intermediate degree and low frequency. The aim of this study is to analyse their clinical characteristics and the importance of different histopathological factors in their prognosis.
Multicentre cooperative group EMETNE prospectively reviewed 153 patients operated on between 1998 and 2016 with diagnosis of atypical carcinoids. Clinical variables and histopathological features were assessed.
Mean age was 54.36 years, similar for both genders. Concerning pathological study, mean tumour size was 31.7 mm. Rosettes were presented in 17% of the cases and tumoural necrosis in 23.3%. The cell proliferation factor Ki-67 index was 10.7%. The 2- and 5-year overall survival rates were 95.8% and 88.9%, respectively. In the univariate study, statistically significant differences in survival were found for each of the categories of T, N and M factors. Mitotic index and quantification of expression of Ki-67 showed influence in overall survival, although without statistical significance. In the multivariate analysis, factors N, M and mitotic index behaved as independent prognostic factors related to survival. Median disease-free interval in the series was 163.35 months. In cases with loco-regional recurrence, 53% had positive hiliar or mediastinal nodal involvement at the time of the surgery. In the univariate analysis, we observed statistically significant differences in disease-free interval in patients with nodal involvement (P = 0.024) and non-anatomical resections (P = 0.04). Histological characteristics showed no statistically significant differences in disease-free interval.
Lymph node involvement, the development of distant metastasis and mitotic index, more than Ki-67 determination, were shown as independent prognostic factors related to survival of these patients.
非典型类癌是一种中等程度和低频率的神经内分泌肿瘤。本研究旨在分析其临床特征以及不同组织病理学因素在其预后中的重要性。
多中心合作小组 EMETNE 前瞻性回顾了 1998 年至 2016 年间诊断为非典型类癌的 153 例手术患者。评估了临床变量和组织病理学特征。
平均年龄为 54.36 岁，男女比例相似。关于病理研究，平均肿瘤大小为 31.7 毫米。有 17%的病例存在玫瑰花结，23.3%的病例存在肿瘤坏死。细胞增殖因子 Ki-67 指数为 10.7%。2 年和 5 年总生存率分别为 95.8%和 88.9%。在单因素研究中，T、N 和 M 因素的每个分类在生存方面均有统计学差异。有丝分裂指数和 Ki-67 表达的定量显示对总生存有影响，但无统计学意义。在多因素分析中，N、M 和有丝分裂指数因素表现为与生存相关的独立预后因素。本系列的中位无病间隔时间为 163.35 个月。在局部复发的病例中，53%的病例在手术时存在肝门或纵隔淋巴结阳性受累。在单因素分析中，我们观察到有淋巴结受累（P=0.024）和非解剖性切除术（P=0.04）的患者无病间隔时间存在统计学差异。组织学特征在无病间隔时间上无统计学差异。
淋巴结受累、远处转移的发生和有丝分裂指数，而不是 Ki-67 测定，被证明是与这些患者生存相关的独立预后因素。
