Martini N, Zaman M B, Bains M S, Burt M E, McCormack P M, Rusch V W, Ginsberg R J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.
J Thorac Cardiovasc Surg. 1994 Jan;107(1):1-6; discussion 6-7.
From 1953 to 1992, 25 patients were surgically treated for bronchial carcinoids with metastases to regional lymph nodes (N1 or N2). The tumors were located centrally, involving main or lobar bronchi in 12 patients and were peripheral in 13. Histologically, 12 of the carcinoids were classified as typical and 13 as atypical (neuroendocrine carcinoma). Pneumonectomy was performed in 11 patients, sleeve lobectomy in one, lobectomy in seven and bilobectomy in six. A formal mediastinal lymph node dissection was done in 20 patients. At final staging, 10 had N1 disease and 15 had N2. No adjuvant treatment was given to the 10 patients with N1 disease. External radiation therapy was given after the operation to 9 of 15 patients with N2 disease. The overall 5-year survival (Kaplan-Meier) was 75% (median 62 months). No difference in survival was found between patients with N1 or N2 disease. However, survival and recurrence rate differed between typical and atypical carcinoids. In typical carcinoids, the 5-year survival was 92% and, in atypical carcinoids, it was 60% (p = 0.02). We conclude that complete resection for bronchial carcinoids results in long-term survival despite the presence of regional lymph node metastases. Recurrence appears to depend more on cell type than nodal status. Postoperative radiation therapy does not appear to be beneficial.
1953年至1992年期间，25例发生区域淋巴结转移（N1或N2）的支气管类癌患者接受了手术治疗。肿瘤位于中央，累及主支气管或叶支气管的有12例，位于外周的有13例。组织学上，12例类癌被分类为典型类癌，13例为非典型类癌（神经内分泌癌）。11例患者接受了全肺切除术，1例接受了袖状肺叶切除术，7例接受了肺叶切除术，6例接受了双肺叶切除术。20例患者进行了正规的纵隔淋巴结清扫术。最终分期时，10例为N1期疾病，15例为N2期疾病。10例N1期疾病患者未接受辅助治疗。15例N2期疾病患者中有9例术后接受了外照射治疗。总体5年生存率（Kaplan-Meier法）为75%（中位生存期62个月）。N1期或N2期疾病患者的生存率无差异。然而，典型类癌和非典型类癌的生存率和复发率有所不同。典型类癌的5年生存率为92%，非典型类癌为60%（p = 0.02）。我们得出结论，尽管存在区域淋巴结转移，但支气管类癌的完整切除仍可带来长期生存。复发似乎更多地取决于细胞类型而非淋巴结状态。术后放疗似乎并无益处。
