Marty-Ané C H, Costes V, Pujol J L, Alauzen M, Baldet P, Mary H
Service de Chirurgie Thoracique et Vasculaire, Hôpital Arnaud de Villeneuve, Montpellier, France.
Ann Thorac Surg. 1995 Jan;59(1):78-83. doi: 10.1016/0003-4975(94)00630-P.
Atypical carcinoids are an intermediate form of tumor between low-grade malignant typical carcinoid and high-grade malignant small cell carcinoma, which represent the two ends of the spectrum of neuroendocrine bronchopulmonary tumors. Between 1983 and 1993, 27 patients with atypical carcinoids underwent surgical treatment. The histologic diagnosis of an atypical carcinoid was established if the criteria proposed by Arrigoni and associates were fulfilled. Seven pneumonectomies, 16 lobectomies, 2 segmentectomies, and 2 wedge resections were performed. Thirteen patients (48.1%) had regional nodal metastases and 6 patients (22%) had N2 disease at the time of surgical therapy. Distant metastases developed in 5 patients (18.5%) after initial treatment. The 10-year survival in patients with an atypical carcinoid was 49%, versus the 84% 10-year survival rate observed in patients with a typical carcinoid. We conclude that the aggressive behavior of atypical carcinoids precludes the use of limited surgical resection and requires a more aggressive approach, with lobectomy and mediastinal lymph node dissection constituting a minimal procedure. The same criteria used for well-differentiated lung carcinoma should apply to this form of neuroendocrine lung tumor. Adjuvant chemotherapy is recommended for patients with stage III or distant metastases.
非典型类癌是一种介于低级别恶性典型类癌和高级别恶性小细胞癌之间的肿瘤中间形式，典型类癌和小细胞癌分别代表神经内分泌性支气管肺肿瘤谱系的两端。1983年至1993年间，27例非典型类癌患者接受了手术治疗。如果满足Arrigoni及其同事提出的标准，则确立非典型类癌的组织学诊断。实施了7例全肺切除术、16例肺叶切除术、2例肺段切除术和2例楔形切除术。13例患者（48.1%）有区域淋巴结转移，6例患者（22%）在手术治疗时存在N2期疾病。5例患者（18.5%）在初始治疗后出现远处转移。非典型类癌患者的10年生存率为49%，而典型类癌患者的10年生存率为84%。我们得出结论，非典型类癌的侵袭性特征排除了有限手术切除的应用，需要采取更积极的方法，肺叶切除术和纵隔淋巴结清扫术是最低限度的手术方式。用于高分化肺癌的相同标准应适用于这种神经内分泌性肺肿瘤。对于Ⅲ期或有远处转移的患者，建议进行辅助化疗。
