Data regarding patients with lung carcinoids, who underwent surgical resection and lymphadenectomy in five institutions from January 1, 2005 to December 31, 2019, were collected and retrospectively analyzed. Clinical and pathological tumor characteristics were correlated to analyze lymph node upstaging.

Results

The analysis was conducted on 283 patients. Pathology showed 230 typical and 53 atypical carcinoids. Nodal and mediastinal upstaging occurred in 33 (11.6%) and 16 (5.6%) patients, respectively. At the univariable analysis, nodal upstaging was significantly correlated with central location (p = 0.003), atypical histology (p < 0.001), pT dimension (p = 0.004), and advanced age (p = 0.043). The multivariable analysis confirmed atypical histology (odds ratio [OR]: 11.030; 95% confidence interval [CI]: 4.837−25.153, p < 0.001) and central location (OR: 3.295; 95% CI: 1.440−7.540, p = 0.005) as independent prognostic factors for nodal upstaging. Atypical histology (p < 0.001), pT dimension (p = 0.036), number of harvested lymph node stations (p = 0.047), and type of lymphadenectomy (p < 0.001) correlated significantly with mediastinal upstaging. The multivariable analysis confirmed atypical histology (OR: 5.408; 95% CI: 1.391−21.020, p = 0.015) and pT (OR: 1.052; 95% CI: 1.021−1.084, p = 0.001) as independent prognostic factors.

Conclusion

Atypical histology, dimension, and central location are associated with a high-risk for occult hilo-mediastinal metastases, and mediastinal radical dissection may predict nodal upstaging. Thus, we suggest radical mediastinal lymph node dissection in high-risk tumors, reserving sampling, or lobe-specific dissection in peripheral, small typical carcinoids.

CONFLICTS OF INTEREST

The authors declare no conflicts of inerest.

Open Research

DATA AVAILABILITY STATEMENT

Data are property of Institutions and can be shared after request evaluation.

Supporting Information

REFERENCES

1Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003; 97: 934-959.
10.1002/cncr.11105
PubMed Web of Science® Google Scholar
2Yao JC, Hassan M, Phan A, et al. One hundred years after “Carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. Jclin Oncol. 2008; 26: 3063-3072.
10.1200/JCO.2007.15.4377
PubMed Web of Science® Google Scholar
3Singh S, Bergsland EK, Card CM, et al. Commonwealth Neuroendocrine Tumour Research Collaboration and the North American Neuroendocrine Tumor Society Guidelines for the diagnosis and management of patients with lung neuroendocrine tumors: an international collaborative endorsement and update of the 2015 European Neuroendocrine Tumor Society Expert Consensus Guidelines. J Thorac Oncol. 2020; 15(10): 1577-1598. doi:10.1016/j.jtho.2020.06.021
10.1016/j.jtho.2020.06.021
PubMed Web of Science® Google Scholar
4Detterbeck F. Management of carcinoid tumors. Ann Thorac Surg. 2010; 89: 998-1005.
10.1016/j.athoracsur.2009.07.097
PubMed Web of Science® Google Scholar
5Kneuertz PJ, Kamel MK, Stiles BM, et al. Incidence and prognostic significance of carcinoid lymph node metastases. Ann Thorac Surg. 2018; 106(4): 981-988. doi:10.1016/j.athoracsur.2018.05.044
10.1016/j.athoracsur.2018.05.044
PubMed Web of Science® Google Scholar
6Filosso PL, Guerrera F, Evangelista A, et al. Prognostic model of survival for typical bronchial carcinoid tumours: analysis of 1109 patients on behalf of the European Association of Thoracic Surgeons (ESTS) Neuroendocrine Tumours Working Group. EurJCardiothorac Surg. 2015; 48: 441-447.
10.1093/ejcts/ezu495
PubMed Web of Science® Google Scholar
7Filosso PL, Guerrera F, Falco NR, et al. Anatomical resections are superior to wedge resections for overall survival in patients with stage 1 typical carcinoids. Eur J Cardiothorac Surg. 2019; 55(2): 273-279. doi:10.1093/ejcts/ezy250
10.1093/ejcts/ezy250
PubMed Web of Science® Google Scholar
8Cardillo G, Sera F, Di Martino M, et al. Bronchial carcinoid tumors: nodal status and long-term survival after resection. Ann Thorac Surg. 2004; 77: 1781-1785.
10.1016/j.athoracsur.2003.10.089
PubMed Web of Science® Google Scholar
9Daddi N, Schiavon M, Filosso PL, et al. Multi-Institutional Italian Pathology Group. Prognostic factors in a multicentre study of 247 atypical pulmonary carcinoids. Eur J Cardiothorac Surg. 2014; 45(4): 677-686. doi:10.1093/ejcts/ezt470
10.1093/ejcts/ezt470
PubMed Web of Science® Google Scholar
10Cusumano G, Fournel L, Strano S, et al. Surgical resection for pulmonary carcinoid: long-term results of multicentric study—the importance of pathological N status, more than we thought. Lung. 2017; 195(6): 789-798. doi:10.1007/s00408-017-0056-8
10.1007/s00408-017-0056-8
PubMed Web of Science® Google Scholar
11Travis WD, Brambilla E, Mueller_Hermelink HK, Harris CC. Pathology and Genetics of Tumours of the Lung, Pleura,Thymus and Heart. IARC Press; 2004.
Google Scholar
12Lococo F, Rapicetta C, Mengoli MC, et al. Diagnostic performances of 68 Ga-DOTATOC versus 18 Fluorodeoxyglucose positron emission tomography in pulmonary carcinoid tumours and interrelationship with histological features. Interact Cardiovasc Thorac Surg. 2019; 28(6): 957-960. doi:10.1093/icvts/ivz009
10.1093/icvts/ivz009
PubMed Web of Science® Google Scholar
13Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P. Members of IASLC Staging Committee. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2009; 4(5): 568-577.
10.1097/JTO.0b013e3181a0d82e
PubMed Web of Science® Google Scholar
14Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg. 2006; 30(5): 787-792. doi:10.1016/j.ejcts.2006.08.008
10.1016/j.ejcts.2006.08.008
PubMed Web of Science® Google Scholar
15Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016; 11(1): 39-51. doi:10.1016/j.jtho.2015.09.009
10.1016/j.jtho.2015.09.009
PubMed Web of Science® Google Scholar
16Medbery RL, Gillespie TW, Liu Y, et al. Nodal upstaging is more common with thoracotomy than with VATS during lobectomy for early-stage lung cancer: an analysis from the national cancer data base. J Thorac Oncol. 2016; 11(2): 222-233.
10.1016/j.jtho.2015.10.007
PubMed Web of Science® Google Scholar
17Boffa DJ, Kosinski AS, Paul S, Mitchell JD, Onaitis M. Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg. 2012; 94(2): 347-353.
10.1016/j.athoracsur.2012.04.059
PubMed Web of Science® Google Scholar
18Chiappetta M, Leuzzi G, Sperduti I, et al. Mediastinal up-staging during surgery in non-small-cell lung cancer: which mediastinal lymph node metastasis patterns better predict the outcome? A multicenter analysis. Clin Lung Cancer. 2020; S1525-S7304(20): 30082-30086. doi:10.1016/j.cllc.2020.03.004
Google Scholar
19Brown LM, Cooke DT, Jett JR, David EA. Extent of resection and lymph node assessment for clinical stage T1aN0M0 typical carcinoid tumors. Ann Thorac Surg. 2018; 105(1): 207-213. doi:10.1016/j.athoracsur.2017.07.049
10.1016/j.athoracsur.2017.07.049
PubMed Web of Science® Google Scholar
20Escalon J, Detterbeck F. Carcinoid tumors. In: T Shields, JI LoCicero, C Reed, R Feins, eds. General Thoracic Surgery. 7th ed. Lippincott Williams & Wilkins; 2009: 1539-1554.
Google Scholar
21García-Yuste M, Matilla JM, Cueto A, et al. Typical and atypical carcinoid tumours: analysis of the experience of the Spanish multi-centric study of neuroendocrine tumours of the lung. Eur J Cardiothorac Surg. 2007; 31: 192-197.
10.1016/j.ejcts.2006.11.031
PubMed Web of Science® Google Scholar
22Westin GFM, Alsidawi S, Leventakos K, Halfdanarson TR, Molina JR. Impact of adjuvant chemotherapy in non-metastatic node positive bronchial neuroendocrine tumors (BNET). J Clin Oncol. 2017; 35(15 suppl): 8533.
10.1200/JCO.2017.35.15_suppl.8533
Web of Science® Google Scholar
23Wegner RE, Abel S, Hasan S, et al. The role of adjuvant therapy for atypical bronchopulmonary carcinoids. Lung Cancer. 2019; 131: 90-94.
10.1016/j.lungcan.2019.03.022
PubMed Web of Science® Google Scholar
24Chen X, Pang Z, Wang Y, et al. The role of surgery for atypical bronchopulmonary carcinoid tumor: development and validation of a model based on Surveillance, Epidemiology, and End Results (SEER) database. Lung Cancer. 2020; 139: 94-102. doi:10.1016/j.lungcan.2019.11.006
10.1016/j.lungcan.2019.11.006
PubMed Web of Science® Google Scholar
25Gosain R, Mukherjee S, Yendamuri SS, Iyer R. Management of typical and atypical pulmonary carcinoids based on different established guidelines. Cancers (Basel). 2018;12 10(12):510. doi:10.3390/cancers10120510
10.3390/cancers10120510
CAS PubMed Web of Science® Google Scholar
26Chiappetta M, Sperduti I, Ciavarella LP, et al. Prognostic score for survival with pulmonary carcinoids: the importance of associating clinical with pathological characteristics. Interact Cardiovasc Thorac Surg. 2020; 31(3): 315-323. doi:10.1093/icvts/ivaa114
10.1093/icvts/ivaa114
PubMed Web of Science® Google Scholar
27Benson RE, Rosado-de-Christenson ML, Martínez-Jiménez S, Kunin JR, Pettavel PP. Spectrum of pulmonary neuroendocrine proliferations and neoplasms. Radiographics. 2013; 33: 1631-1649.
10.1148/rg.336135506
PubMed Web of Science® Google Scholar
28Lococo F, Perotti G, Cardillo G, et al. Multicenter comparison of 18F-FDG and 68Ga-DOTA-peptide PET/CT for pulmonary carcinoid. Clin Nucl Med. 2015; 40(3): e183-e189.
10.1097/RLU.0000000000000641
PubMed Web of Science® Google Scholar
29Chiappetta M, Rosella F, Dall'armi V, et al. CT-guided fine-needle ago-biopsy of pulmonary nodules: predictive factors for diagnosis and pneumothorax occurrence. Radiol Med. 2016; 121(8): 635-643. doi:10.1007/S11547-016-0639-0
10.1007/s11547-016-0639-0
PubMed Web of Science® Google Scholar
30Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143(5 suppl): e142S-e1465.
10.1378/chest.12-2353
PubMed Web of Science® Google Scholar

Citing Literature

Volume126, Issue3

September 1, 2022

Pages 588-598

Lymphadenectomy for lung carcinoids: Which factors may predict nodal upstaging? A multi centric, retrospective study

Correction(s) for this article

Erratum

Abstract

Objective

Methods

Results

Conclusion

CONFLICTS OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Lymphadenectomy for lung carcinoids: Which factors may predict nodal upstaging? A multi centric, retrospective study

Correction(s) for this article

Erratum

Abstract

Objective

Methods

Results

Conclusion

CONFLICTS OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Related

Information