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Chen YQ, Li YF, Zhang CY, Zhang SL, Lv ZY, Dong S, Chen HJ, Zhang XC, Wu YL, Yang JJ. Response to Icotinib Plus Chemotherapy in Pulmonary Atypical Carcinoid Harboring the EGFR L858R Mutation: A Brief Report. JTO Clin Res Rep 2021; 2:100258. [PMID: 34917992 PMCID: PMC8668983 DOI: 10.1016/j.jtocrr.2021.100258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Pulmonary atypical carcinoid (PAC) is a rare subtype of pulmonary neuroendocrine neoplasm. Although EML4-ALK fusion has been detected in PAC, EGFR mutations have not been reported before. Methods We performed hematoxylin and eosin staining, immunohistochemistry, and next-generation sequencing on tissues at baseline and after surgery. Results The patient was diagnosed with having advanced PAC harboring the EGFR L858R mutation and then received a combination of icotinib and irinotecan plus cisplatin chemotherapy, achieving a partial response before the operation. Postoperative histology results revealed SCLC harboring the EGFR L858R mutation. Surprisingly, both the KRAS amplification and the RB1 deletion disappeared. Conclusions EGFR tyrosine inhibitors plus irinotecan plus cisplatin chemotherapy might be a potential treatment option for advanced pulmonary neuroendocrine neoplasms harboring EGFR mutations.
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Chiappetta M, Sperduti I, Ciavarella LP, Leuzzi G, Bria E, Mucilli F, Lococo F, Filosso P, Ratto G, Spaggiari L, Facciolo F, Margaritora S. Prognostic score for survival with pulmonary carcinoids: the importance of associating clinical with pathological characteristics. Interact Cardiovasc Thorac Surg 2021; 31:315-323. [PMID: 32747930 DOI: 10.1093/icvts/ivaa114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/13/2020] [Accepted: 05/24/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Lung carcinoids (LCs) are staged using the non-small-cell lung cancer tumour/node/metastasis staging system; the possibility of an LC-specific staging system is still being debated. The goal of our study was to construct a composite prognostic score for LC. METHODS From January 2002 to December 2014, data from 293 patients who underwent surgical treatment for LC in 7 research institutes were retrospectively analysed. A panel of established prognostic factors in addition to lymph node metastasis patterns (single/multiple N1-N2 station, skip metastasis, lobe specific), numbers of lymph nodes resected and the ratio between the numbers of metastatic lymph nodes and the numbers of lymph nodes resected (node ratio) were correlated to overall survival (OS) and disease-free survival (DFS). The log-hazard ratio (HR), obtained from the Cox model, was used to derive weighting factors for a continuous prognostic index, designed to identify differential outcome risks. The score was dichotomized according to maximally selected log-rank statistics. RESULTS Pathological analysis showed typical carcinoids in 223 (76.1%) and atypical carcinoids in 70 (23.9%) patients; the tumour/node/metastasis pattern was stage I in 72.4%, stage II in 18.1%, stage III in 9.5% and stage IV in 0.03% cases. The median numbers of lymph nodes resected was 12 (range 0-53); hilar and mediastinal node metastases were identified in 14% and 6.8% of cases, respectively. Overall, the 5-year OS and 5-year DFS rates were 90.6% and 76.7%, respectively. At multivariable analysis, sex, age, pathological T stage and node ratio were significantly related to a better OS; age, histological type, pathological T stage and node ratio were related to DFS. These factors were used to generate the prognostic score, which showed statistically significant differences between the high-risk and low-risk groups: 5-year OS = 96.6% if score <3.1 vs 63.5% if score ≥3.1 [P < 0.0001; HR 17.56, 95% confidence interval (CI) 5.45-56.53]; 5-year DFS 92.3% if score <1.5 vs 52.5% if score ≥ 1.5 (P < 0.0001; HR 7.95, 95% CI 3.48-18.16). CONCLUSIONS The proposed prognostic scores seem to be effective in predicting outcomes for patients with LCs.
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Affiliation(s)
- Marco Chiappetta
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Isabella Sperduti
- Biostatistics, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Leonardo Petracca Ciavarella
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Leuzzi
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilio Bria
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Mucilli
- General and Thoracic Surgery, University Hospital "SS. Annunziata", Chieti, Italy
| | - Filippo Lococo
- Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Pierluigi Filosso
- Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy
| | | | - Lorenzo Spaggiari
- Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Regina Elena National Cancer Institute-IFO, Rome, Italy
| | - Stefano Margaritora
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Wen J, Chen J, Liu D, Chen D, Chen Y, Fan M, Lu B. Proposal of organ-specific subdivision of M component and staging system for metastatic pulmonary neuroendocrine tumor. Lung Cancer 2020; 148:86-93. [PMID: 32846318 DOI: 10.1016/j.lungcan.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the prognostic significance of patterns of distant metastatic organs in metastatic pulmonary neuroendocrine tumors (PNETs). METHODS 891 metastatic PNETs patients (G1-typical carcinoid, 200; G2-atypical carcinoid, 68; G3-large-cell neuroendocrine carcinoma, 623) diagnosed between 2010 and 2016 were identified. Multivariate analysis was performed using a Cox regression model to identify prognostic factors associated with cancer-specific survival (CSS). The novel M component was established based on the hazard ratio of different metastatic organs. A disease-specific staging system was then proposed by using k-means cluster analysis. RESULTS For metastatic PNETs, involvement of bone, liver or brain and multiple metastatic organs were identified as independent prognostic factors in multivariate analysis. M categories was subdivided into three subcategories: M1a, lung involvement only or distant lymph node involvement only; M1b, bone involvement only or liver involvement only; M1c, brain involvement regardless of number of metastatic organs or multiple organs involvement except brain. Primary site surgery, chemotherapy and histologic subtypes were independently associated with CSS, but T component and N component were not. After regrouping histologic subtypes and novel M component, we proposed the following modified staging system: stage IVA (G1M1any, G2M1a-b), stage IVB (G2M1c, G3M1a-b) and stage IVC (G3M1c). The 2-year CSS were 77.9 %, 16.4 % and 5.3 %. CONCLUSIONS Subdivision of M component according to patterns of distant metastatic organs facilitates prognostic significance for PNETs. Brain metastases and multiple metastatic organs were associated with significantly inferior prognosis. Incorporating histologic subtypes and novel M categories create a disease-specific staging system showed good discriminatory capacity.
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Affiliation(s)
- Junmiao Wen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Jiayan Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Di Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China.
| | - Bo Lu
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania PA, USA
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Bu X, Wang X, Wei L, Liu J, Chen M. The Risk of Second Primary Malignancies in Patients With Lung Neuroendocrine Tumors: A Population-Based Study on SEER Database. Curr Probl Cancer 2020; 44:100613. [PMID: 32563531 DOI: 10.1016/j.currproblcancer.2020.100613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/22/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE We investigated the at-risk sites of second primary malignancies (SPMs) and evaluate the risk factors of SPMs among lung neuroendocrine tumors (LNETs) survivors by using the surveillance, epidemiology, and end results (SEER) database. METHODS Propensity-score matching was performed to conduct a case-control study from the surveillance, epidemiology, and end results (SEER) database. Cox regression analysis and multiple primary standardized incidence ratios were performed to investigate the risk factors of occurrence of SPMs among patients with LNETs. RESULTS Of 3,206 patients with LNETs after matching, 539 developed SPMs. The risk of developing SPMs was higher in older patients (55-74 vs ≦54: hazard ratios [HR] 1.875; age ≧75 vs ≦54: HR 2.713), higher-stage of LNETs (regional vs localized: HR 1.387; distant vs localized: HR 2.732) and recent periods of diagnosis (2004-2014 vs 1984-1993: HR 1.735). Patients with SCLC, TC and LENEC had a higher risk for SPMs compared to general population. Lung and bronchus, larynx and some digestive organs had higher risk for SPMs while some sex hormone related organs like prostate, breast, and female reproductive system had a lower incidence of SPMs. CONCLUSIONS Patients with LNETs had overall higher risks of SPMs than general population. Different types of second primary malignancies occurred in different periods after LNETs were diagnosed. Further investigations are required to screen different second primary malignancies for those with primary LNETs.
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Affiliation(s)
- Xiang Bu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xiqiang Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Key Laboratory of Molecular Cardiology, Shaanxi Province, China
| | - Linyan Wei
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Key Laboratory of Molecular Cardiology, Shaanxi Province, China
| | - Jing Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Key Laboratory of Molecular Cardiology, Shaanxi Province, China
| | - Mingwei Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Shaanxi Provincial Research Center for the Project of Prevention and Treatment of Respiratory Diseases, Xi'an, Shaanxi, China.
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Zhang S, Xue Z, Wen J, Wang B, Chu X. [Surgical Resection and Prognosis of Bronchopulmonary Carcinoid]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:494-499. [PMID: 31451139 PMCID: PMC6717871 DOI: 10.3779/j.issn.1009-3419.2019.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bronchopulmonary carcinoid (BPC) is a rare neuroendocrine tumor, the clinical studies on treatment and prognostic factors of BPC are somewhat controversial. Our purpose was to evaluate the clinical efficacy of surgery on BPC, and to analyze the prognostic factors affecting the survival of BPC. METHODS We retrospectively collected the clinical data of patients with BPC admitted to the Chinese PLA General Hospital between January 2000 and December 2017. The Kaplan-Meier method was used to calculate the survival rate of patients and to map the survival curve. Then the effects of different factors like pathological classification, gender, age, on prognosis were compared by univariate analysis and multivariate analysis was made by Cox proportional hazard model. RESULTS A total of 98 patients had a diagnosis of BPC were included in the study. There were 41 patients with typical carcinoid (TC) and 57 patients with atypical carcinoid (AC). The 1-yr, 5-yr, and 10-yr overall survival rates of BPC were 96.9%, 80.0% and 73.6%, respectively. Univariate analysis showed age (P=0.000,1), smoking history (P=0.005), pathological subtype (P<0.000,1), T stage (P=0.000,2), TNM stage (P<0.000,1) were the prognostic factors. Multivariate analysis showed that age (P=0.005) and tumor stage (P=0.017) were independent prognostic factors. CONCLUSIONS BPC occurred more in middle-aged men. Surgery is the main treatment for lung cancer, and the overall prognosis is good. Age and TNM stage were independent risk factors for long-term survival after lung cancer surgery.
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Affiliation(s)
- Shaowei Zhang
- Department of Thoracic Surgery, PLA General Hospital, Beijing 100853, China
| | - Zhiqiang Xue
- Department of Thoracic Surgery, PLA General Hospital, Beijing 100853, China
| | - Jiaxin Wen
- Department of Thoracic Surgery, PLA General Hospital, Beijing 100853, China
| | - Bo Wang
- Department of Thoracic Surgery, PLA General Hospital, Beijing 100853, China
| | - Xiangyang Chu
- Department of Thoracic Surgery, PLA General Hospital, Beijing 100853, China
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Huang Y, Yang X, Lu T, Li M, Zhao M, Yang X, Ma K, Wang S, Zhan C, Liu Y, Wang Q. Assessment of the prognostic factors in patients with pulmonary carcinoid tumor: a population-based study. Cancer Med 2018; 7:2434-2441. [PMID: 29733505 PMCID: PMC6010747 DOI: 10.1002/cam4.1515] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 01/27/2023] Open
Abstract
Previous studies have identified potential risk factors for pulmonary carcinoid tumors and evaluated the effect of various treatments; however, the results were not entirely consistent. We conducted a population‐based study to further explore relevant prognostic issues. We extracted cases with pulmonary carcinoid tumors from the Surveillance Epidemiology and End Results database. Cox proportional hazard regression was utilized to identify potential significant risk factors, which helped establish a nomogram for predicting long‐term survival. Survival analysis and a competing risk study were conducted to evaluate the value of different surgical approaches. There were 7057 cases included in the study. Univariate and multivariate analyses showed that age, sex, tumor size, stage, histology, surgical type, chemotherapy, and radiation therapy were all significant prognostic factors. A nomogram with good accuracy for predicting 10‐year survival was formulated. Furthermore, patients who had undergone surgery had a significantly better survival than those who did not undergo surgery. There was no significant prognostic difference between lobectomy and sublobectomy stratified by tumor stage; however, lobectomy was associated with a significantly better survival in atypical tumors, especially those with regional disease. Our research identified possible risk factors in a large cohort and constructed a nomogram to visually predict 10‐year survival of pulmonary carcinoid tumors. We showed that lobectomy and sublobectomy should be considered as the mainstay of treatment, especially lobectomies for atypical tumor.
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Affiliation(s)
- Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Tao Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Ming Li
- Eight-year Program Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Xingyu Yang
- Eight-year Program Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ke Ma
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Yu Liu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China
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Tsoukalas N, Baxevanos P, Aravantinou-Fatorou E, Tolia M, Galanopoulos M, Tsapakidis K, Kyrgias G, Toumpanakis C, Kaltsas G. Advances on systemic treatment for lung neuroendocrine neoplasms. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:146. [PMID: 29862235 DOI: 10.21037/atm.2018.04.03] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lung well-to-moderately differentiated neuroendocrine tumors (also known as carcinoids) and large cell neuroendocrine lung carcinoma (poorly differentiated neuroendocrine tumor) are rare neuroendocrine neoplasms, which account for less than 4% of all lung neoplasms. Due to their low incidence, their systemic treatment is greatly influenced by therapeutic evidence derived from the more frequent gastroenteropancreatic neuroendocrine neoplasms and/or small cell lung carcinoma leading to significant bias. Currently, employed systemic therapies for lung carcinoids, aiming at controlling tumor growth include long acting somatostatin analogues (SSAs), peptide receptor radionuclide therapy, chemotherapy and molecular-targeted therapy. In this review, each of those treatments is presented based upon available clinical evidence from retrospective and prospective studies particularly focused on the role of everolimus in the advanced setting and on ongoing clinical trials reflecting our expectations in the near future. In addition, we critically analyse currently employed treatment of large cell neuroendocrine carcinoma where the appropriate chemotherapeutic regimen is still a matter of debate.
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Affiliation(s)
| | | | | | | | | | | | | | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Gregory Kaltsas
- 1st Propaepeudic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Erlotinib for coexisting typical bronchial carcinoid and advanced lung adenocarcinoma: does the epidermal growth factor receptor mutation status matter? Anticancer Drugs 2017; 29:281-285. [PMID: 29280916 DOI: 10.1097/cad.0000000000000587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adenocarcinoma (AC) is the most common type of primary pulmonary malignancy. Lung carcinoid, however, is a rare neuroendocrine tumor. Their coexistence is extremely uncommon. We report the unique case of synchronous advanced lung AC of the right upper lobe (stage IIIB) and typical endobronchial carcinoid tumor in the contralateral lower lobe in a 49-year-old white female who had never smoked. PET-computed tomography scan revealed a fluorine-18-fluorodeoxyglucose-avid AC lesion, whereas the carcinoid tumor was fluorine-18-fluorodeoxyglucose occult. After two lines of platinum-based combination chemotherapies and radiotherapy, the AC progressed, and oral tyrosine kinase inhibitor therapy with erlotinib was initiated in third line. On erlotinib, the AC remained stable for 50 months until disease progression, whereas the carcinoid completely regressed. Molecular testing of the rebronchoscopied AC revealed an exon 19 deletion mutation in the epidermal growth factor receptor (EGFR) gene, whereas the carcinoid was retrospectively EGFR mutation negative. The patient eventually succumbed to ileus caused by intra-abdominal spread of disease, surviving a remarkable 80 months with good performance status throughout most of the follow-up period. To the best of our knowledge, this is the first reported case of synchronous primary lung cancers with different EGFR mutation status, describing an unexpected response of an EGFR-wild-type carcinoid to third-line erlotinib.
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Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size. J Thorac Cardiovasc Surg 2017; 155:405-413. [PMID: 28986041 DOI: 10.1016/j.jtcvs.2017.08.102] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/12/2017] [Accepted: 08/25/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors. METHODS We retrospectively analyzed 510 consecutive patients (female/male, 313/197; median age, 61 years; interquartile range, 51-70) undergoing lung resection for a primary neuroendocrine tumor between 2000 and 2015 in 8 centers. Multivariable analysis was performed using a Cox proportional hazard model to identify factors associated with disease-specific survival. A new staging system was proposed on the basis of the results of this analysis. Kaplan-Meier disease-specific survival was analyzed by stage using the proposed and the 7th TNM staging system. RESULTS Follow-up was completed in 490 of 510 patients at a median of 51 months (interquartile range, 18-99). Histology (G1-typical carcinoid vs G2-atypical carcinoid vs G3-large-cell neuroendocrine carcinoma) and pT were independently associated with survival, but pN was not. After regrouping histology and pT, we proposed the following staging system: IA (pT1-2G1), IB (pT3G1, pT1G2), IIA (pT4G1, pT2-3G2, pT1G3), IIB (pT4G2, pT2-3G3), and III (pT4G3). The 5-year survivals were 97.9%, 81.0%, 69.1%, 51.8%, and 0%, respectively. By using the 7th TNM, 5-year survivals were 95.0%, 92.3%, 67.7%, 70.9%, and 65.1% for stage IA, IB, IIA, IIB, and III, respectively. CONCLUSIONS Incorporating histology and regrouping tumor stage create a unique neuroendocrine tumor staging system that seems to predict survival better than the 7th TNM classification.
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Treatment of Lung Carcinosarcoma and Other Rare Histologic Subtypes of Non-small Cell Lung Cancer. Curr Treat Options Oncol 2017; 18:54. [PMID: 28795312 DOI: 10.1007/s11864-017-0494-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OPINION STATEMENT Lung carcinosarcoma (PCS) and other histological subtypes of non-small cell lung cancer, such as primary pulmonary lymphoma (PPL), pulmonary carcinoid (PC), and primary pulmonary lymphoepithelioma-like carcinoma (LELC), are rare. For their low incidence, the diagnosis and treatment are still controversial. Some patients only need surgery, while others may need chemotherapy, radiotherapy, or targeted therapy. In this paper, we retrospectively reviewed the literature of some rare histological subtype of NSCLC for the recent 20 years, and try to get some conclusions.
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Wu Y, Yue L, Li J, Yuan M, Chai Y. Cushing's syndrome secondary to typical pulmonary carcinoid with mutation in BCOR gene: A case report. Medicine (Baltimore) 2017; 96:e7870. [PMID: 28834902 PMCID: PMC5572024 DOI: 10.1097/md.0000000000007870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Typical pulmonary carcinoid is a kind of low-grade malignancy neuroendocrine tumor. Cushing's syndrome is a very rare clinical feature of typical pulmonary carcinoid caused by hypercorticism. Complete tumor resection is the standard curative treatment for primary typical pulmonary carcinoid. However, our knowledge on the gene level of typical pulmonary carcinoid is limited. PATIENT CONCERNS A 42-year-old man was admitted to our hospital for progressive weight gain within one year. No other obvious symptoms were obsessed in this patient. He was clinical diagnosed with ectopic adrenocorticotropic hormone syndrome through hormonal tests and imaging exams. Positron emission tomography-computed tomography detected a pulmonary nodule localized in the middle lobe of the lung and it is thought to be the ectopic source. INTERVENTION This patient received a pulmonary wedge resection. After the surgery, a genetic sequencing was performed and it reported a mutation (S1240Cfs*21) in the BCOR gene. DIAGNOSIS Postoperative pathology confirmed the diagnosis of ACTH-producing typical pulmonary carcinoid. OUTCOMES The patient had a smooth postoperative course and no recurrence of the tumor was found for 3 years. LESSONS Mutation in BCOR gene is quite common in pulmonary neuroendocrine tumor and it has been proven to play a role in the development of some tumor. We herein first report BCOR gene mutation in Cushing's syndrome secondary to TPC and it may become a promising therapeutic target in the future.
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Affiliation(s)
- Yimin Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Lan Yue
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Jinfan Li
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | | | - Ying Chai
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
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12
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Wolin EM. Advances in the Diagnosis and Management of Well-Differentiated and Intermediate-Differentiated Neuroendocrine Tumors of the Lung. Chest 2017; 151:1141-1146. [DOI: 10.1016/j.chest.2016.06.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022] Open
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13
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FAIM2, as a novel diagnostic maker and a potential therapeutic target for small-cell lung cancer and atypical carcinoid. Sci Rep 2016; 6:34022. [PMID: 27677402 PMCID: PMC5039724 DOI: 10.1038/srep34022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/06/2016] [Indexed: 12/23/2022] Open
Abstract
Lung neuroendocrine (NE) tumors are a heterogeneous group of tumors arising from neuroendocrine cells that includes typical carcinoid, atypical carcinoid, small cell lung cancer (SCLC), and large cell NE cancer. The subtyping of NE tumors is based on the number of mitoses per high powered field and the presences of necrosis. However, the best diagnostic criteria to differentiate various subtypes of lung NE tumors remains controversial and few diagnostic markers distinguish typical and atypical carcinoid. In this study, we show that FAIM2, an inhibitory molecule in the Fas-apoptosis pathway, is significantly overexpressed in SCLC compared to non-small cell lung cancer. In addition, FAIM2 expression is significantly higher in atypical carcinoid than typical carcinoid. As atypical carcinoid has been shown to have worse clinical outcomes than typical carcinoid, our data suggests that FAIM2 may be a useful diagnostic marker for atypical carcinoid. Knockdown of FAIM2 expression increases Fas-induced apoptotic cell death in SCLC cells. Etoposide treatment combined with FAIM2 inhibition also shows modest but significant reduction of viable SCLC cells. Taken together, our results suggest that FAIM2 is a potential NE tumor marker with higher expression in atypical carcinoid and SCLC, and could be a new therapeutic target for SCLC.
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