Elliott Irmina A, Liou Douglas Z, Lui Natalie S, Backhus Leah M, Shrager Joseph B, Myall Nathaniel, Berry Mark F
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Ann Thorac Surg Short Rep. 2023 Aug 22;1(4):543-547. doi: 10.1016/j.atssr.2023.07.016. eCollection 2023 Dec.
Observation has been suggested as an alternative to surgical resection for small typical lung carcinoids. We sought to evaluate the potential impact of tumor growth and lymphatic spread during observation by examining predictors of node positivity and the impact of tumor size and node status on survival.
National Cancer Database cases of typical lung carcinoid resections from 2006 to 2016 were analyzed. Predictors of lymph node involvement and survival were determined.
Overall, 1019 of 8257 patients who underwent typical carcinoid resection had at least 1 positive node (12.3%). The incidence of node positivity among the 921 patients with subcentimeter tumors was 5.4% (n = 50). Increasing tumor size was independently associated with nodal involvement. Patients with nodal involvement had significantly worse 5-year survival (89.5% vs 94.0%; < .001). Increasing tumor size was not associated with worse survival in multivariable analysis, but node positivity did independently predict worse survival.
More than 5% of patients with subcentimeter typical carcinoids of the lung have nodal metastases, and node involvement is an independent predictor of worse survival, whereas tumor size is not. These data suggest that even patients with small tumors should generally undergo resection when diagnosed.
对于小的典型肺类癌，观察被建议作为手术切除的替代方法。我们试图通过检查淋巴结阳性的预测因素以及肿瘤大小和淋巴结状态对生存的影响，来评估观察期间肿瘤生长和淋巴转移的潜在影响。
分析了国家癌症数据库中2006年至2016年典型肺类癌切除术的病例。确定了淋巴结受累和生存的预测因素。
总体而言，8257例行典型类癌切除术的患者中，1019例至少有1个阳性淋巴结（12.3%）。921例肿瘤直径小于1厘米的患者中，淋巴结阳性发生率为5.4%（n = 50）。肿瘤大小增加与淋巴结受累独立相关。有淋巴结受累的患者5年生存率明显较差（89.5%对94.0%；P <.001）。在多变量分析中，肿瘤大小增加与生存率较差无关，但淋巴结阳性确实独立预测生存率较差。
超过5%的肺典型类癌直径小于1厘米的患者有淋巴结转移，淋巴结受累是生存率较差的独立预测因素，而肿瘤大小不是。这些数据表明，即使是小肿瘤患者在诊断时一般也应接受手术切除。
