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La Salvia A, Marcozzi B, Manai C, Mazzilli R, Landi L, Pallocca M, Ciliberto G, Cappuzzo F, Faggiano A. Rachel score: a nomogram model for predicting the prognosis of lung neuroendocrine tumors. J Endocrinol Invest 2024:10.1007/s40618-024-02346-x. [PMID: 38520655 DOI: 10.1007/s40618-024-02346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Lung NET, classified in typical carcinoids (TC) and atypical carcinoids (AC), are highly heterogeneous in their biology and prognosis. The histological subtype and TNM stage are well-established prognostic factors for lung NET. In a previous work by our group, we demonstrated a significant impact of laterality on lung NET survival outcomes. MATERIALS AND METHODS We developed a nomogram that integrates relevant prognostic factors to predict lung NET outcomes. By adding the scores for each of the variables included in the model, it was possible to obtain a prognostic score (Rachel score). Wilcoxon non-parametric statistical test was applied among parameters and Harrell's concordance index was used to measure the models' predictive power. To test the discriminatory power and the predictive accuracy of the model, we calculated Gonen and Heller concordance index. Time-dependent ROC curves and their area under the curve (AUC) were used to evaluate the models' predictive performance. RESULTS By applying Rachel score, we were able to identify three prognostic groups (specifically, high, medium and low risk). These three groups were associate to well-defined ranges of points according to the obtained nomogram (I: 0-90, II: 91-130; III: > 130 points), providing a useful tool for prognostic stratification. The overall survival (OS) and progression free survival (PFS) Kaplan-Meier curves confirmed significant differences (p < 0.0001) among the three groups identified by Rachel score. CONCLUSIONS A prognostic nomogram was developed, incorporating variables with significant impact on lung NET survival. The nomogram showed a satisfactory and stable ability to predict OS and PFS in this population, confirming the heterogeneity beyond the histopathological diagnosis of TC vs AC.
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Affiliation(s)
- A La Salvia
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy.
| | - B Marcozzi
- Biostatistics, Bioinformatics and Clinical Trial Center, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Cardiovascular, Endocrine-Metabolic Disease and Aging, National Institute of Health (ISS), Rome, Italy
| | - C Manai
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - R Mazzilli
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
| | - L Landi
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Pallocca
- Biostatistics, Bioinformatics and Clinical Trial Center, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - G Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - F Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Faggiano
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, Rome, Italy
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Nisman B, Oleinikov K, Nechushtan H, Maimon O, Atlan K, Peled N, Gross D, Peretz T, Meirovitz A, Grozinsky-Glasberg S. Plasma Progastrin-Releasing Peptide and Chromogranin A Assays for Diagnosing and Monitoring Lung Well-Differentiated Neuroendocrine Tumors: A Brief Report. J Thorac Oncol 2023; 18:369-376. [PMID: 36503175 DOI: 10.1016/j.jtho.2022.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The use of chromogranin A (CGA) as a circulating biomarker in lung carcinoids (LCs) is limited by low specificity and sensitivity. This study aimed to evaluate plasma progastrin-releasing peptide (ProGRPp) as an alternative to plasma CGA (CGAp), for the diagnosis and follow-up of LC. METHODS ProGRPp and CGAp concentrations were measured in 107 patients with LC and 105 patients with benign lung disease (BLD). RESULTS ProGRPp distinguished patients with LC with active disease in the pretreatment (n = 43) and post-treatment (n = 43) groups from those with BLD: area under the curve for both 0.864 (p < 0.0001); sensitivity 67.4% and 58.1%, respectively; specificity 96.2%; at 64 pg/mL cutoff. CGAp failed to differentiate both LC groups from those with BLD: area under the curve 0.579 and 0.526 (for both p > 0.1); sensitivity 34.9% and 25.6%, respectively; specificity 73.3%; at 104 ng/mL cutoff. Only ProGRPp correlated with the Ki67 proliferation index (r = 0.40, p < 0.001) and was associated with mitotic count (p = 0.025), stage (p = 0.018), grade (p = 0.019), and the expression of thyroid transcription factor-1 (p = 0.005). ProGRPp had a high sensitivity (92.3%) in LC with diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Abnormal postoperative ProGRPp level was associated with residual disease (p = 0.029). The changes in ProGRPp level during treatment, a decrease greater than 30% and an increase greater than 8%, were associated with image-based outcomes, partial response and disease progression, respectively (p < 0.0001). CGAp did not reflect the disease course. CONCLUSIONS ProGRPp was superior to CGAp in diagnosing LC with correlations concerning proliferation, grading, staging, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia co-occurrence, and response to treatment. ProGRPp is an optimal emerging biomarker to be further evaluated.
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Affiliation(s)
- Benjamin Nisman
- Department of Oncology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel.
| | - Kira Oleinikov
- Neuroendocrine Tumor Unit, ENETS Centre of Excellence, Endocrinology & Metabolism Department, Hadassah Medical Organization, Jerusalem, Israel
| | - Hovav Nechushtan
- Department of Oncology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
| | - Ofra Maimon
- Department of Oncology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
| | - Karine Atlan
- Department of Pathology, Hadassah Medical Organization, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Nir Peled
- The Institute of Oncology, Shaarei Zedek Medical Center, Jerusalem, Israel
| | - David Gross
- Neuroendocrine Tumor Unit, ENETS Centre of Excellence, Endocrinology & Metabolism Department, Hadassah Medical Organization, Jerusalem, Israel
| | - Tamar Peretz
- Department of Oncology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Amichay Meirovitz
- The Legacy Heritage Oncology Center, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Medicine, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, ENETS Centre of Excellence, Endocrinology & Metabolism Department, Hadassah Medical Organization, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Collins ML, Okusanya O. Current Management of Carcinoid Tumor. Thorac Surg Clin 2023; 33:159-164. [PMID: 37045485 DOI: 10.1016/j.thorsurg.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Bronchopulmonary carcinoid tumors are rare, well-differentiated neuroendocrine neoplasms. They can be categorized as typical or atypical lesions and are low-to-intermediate-grade, respectively. The cornerstone of therapy for carcinoid tumors is surgical resection and current consensus guidelines recommend anatomic resection for stage I to IIIA disease. The renewed interest in sublobar resections for the treatment of lung malignancies has sparked debate over the degree of resection necessary for these indolent lesions. Segmentectomy provides an oncologic resection while preserving as much lung parenchyma as possible, and is a reasonable approach to apply to small, undifferentiated, or typical carcinoid lesions.
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Koehler K, Iams WT. Carcinoid tumors outside the abdomen. Cancer Med 2022; 12:7893-7903. [PMID: 36560885 PMCID: PMC10134339 DOI: 10.1002/cam4.5564] [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: 11/12/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Neuroendocrine tumors (NETs) are epithelial malignancies that can arise from multiple tissues. Gastrointestinal (GI) NETs are the most common; in this review of extra-abdominal carcinoid tumors, we focus our discussion on bronchial and thymic carcinoid tumors. Bronchial carcinoid tumors comprise a quarter of all NETs and less than 2% of all lung cancers. Thymic carcinoid tumors are extremely rare, accounting for 5% of thymic tumors. Both bronchial and thymic carcinoid tumors are histologically classified as either typical or atypical based on their mitotic rate (less than 2 or 2-10 mitoses per 10 high-powered fields (HPF), respectively). Both bronchial and thymic carcinoids can present with symptoms of obstruction and potentially carcinoid syndrome. The gold standard of management of bronchial and thymic carcinoid tumors is surgical resection. For patients with advanced disease, first-line systemic therapy is generally somatostatin analog monotherapy with octreotide or lanreotide. In patients with refractory disease, therapy generally involves peptide receptor radioligand therapy, everolimus, or cytotoxic chemotherapy. There are ongoing, prospective trials comparing the mainstays of systemic therapy for these patients, as well as ongoing evaluations of immune checkpoint inhibitors and multi-kinase inhibitors. Prognosis for both bronchial and thymic carcinoid tumors depends on histologic grade, local versus invasive disease, and extent of metastases. Herein we provide a summary of the pathophysiologic and clinical background, the current state of the field in diagnosis and management, and note of key ongoing prospective trials for patients with bronchial and thymic carcinoid tumors.
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Affiliation(s)
- Kenna Koehler
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wade T Iams
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
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Angioside: The role of Angiogenesis and Hypoxia in Lung Neuroendocrine Tumours According to Primary Tumour Location in Left or Right Parenchyma. J Clin Med 2022; 11:jcm11195958. [PMID: 36233825 PMCID: PMC9570740 DOI: 10.3390/jcm11195958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Well-differentiated lung neuroendocrine tumours (Lu-NETs), classified as typical (TC) and atypical (AC) carcinoids, represent 30% of NETs. Angiogenesis plays an essential role in NET development and progression. A higher vascular network is a marker of differentiation, with positive prognostic implications. Materials and Methods: We retrospectively evaluated microvessel density (MVD) by CD34 immunohistochemical (IHC) staining and hypoxia by IHC staining for Hypoxia-inducible factor 1α (HIF-1α), comparing right- and left-lung parenchyma in 53 lung NETs. Results: The median age was 66 years (39−81), 56.6% males, 24.5% AC, 40.5% left-sided tumours and 69.8% TNM stage I. The mitotic count was <2/10 per 10 HPF in 79.2%, and the absence of necrosis in 81.1%, 39.6% with Ki67, was ≤2%. The MVD, the number of vessels and the average vessel area median values were significantly higher in the right than the left parenchyma (p: 0.025, p: 0.019, p: 0.016, respectively). Hypoxia resulted present in 14/19 (73.6%) left tumours and in 10/20 (50%) right tumours in the parenchyma (p: 0.129). Conclusions: This study suggests a biological rationale for a different angiogenesis and hypoxia according to the Lu-NETs’ location. In our study, left primary tumours were less vascularized and most likely to present hypoxia than right primary tumours. This finding could have potentially useful prognostic and predictive implications for Lu-NETs.
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Groth SS. Commentary: Endobronchial treatment of central airway typical carcinoid tumors: The devil is in the details. JTCVS Tech 2022; 15:165-166. [PMID: 36276665 PMCID: PMC9579704 DOI: 10.1016/j.xjtc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
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La Salvia A, Persano I, Siciliani A, Verrico M, Bassi M, Modica R, Audisio A, Zanata I, Trabalza Marinucci B, Trevisi E, Puliani G, Rinzivillo M, Parlagreco E, Baldelli R, Feola T, Sesti F, Razzore P, Mazzilli R, Mancini M, Panzuto F, Volante M, Giannetta E, Romero C, Appetecchia M, Isidori A, Venuta F, Ambrosio MR, Zatelli MC, Ibrahim M, Colao A, Brizzi MP, García-Carbonero R, Faggiano A. Prognostic significance of laterality in lung neuroendocrine tumors. Endocrine 2022; 76:733-746. [PMID: 35301675 PMCID: PMC9156515 DOI: 10.1007/s12020-022-03015-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Well-differentiated lung neuroendocrine tumors (Lu-NET) are classified as typical (TC) and atypical (AC) carcinoids, based on mitotic counts and necrosis. However, prognostic factors, other than tumor node metastasis (TNM) stage and the histopathological diagnosis, are still lacking. The current study is aimed to identify potential prognostic factors to better stratify lung NET, thus, improving patients' treatment strategy and follow-up. METHODS A multicentric retrospective study, including 300 Lung NET, all surgically removed, from Italian and Spanish Institutions. RESULTS Median age 61 years (13-86), 37.7% were males, 25.0% were AC, 42.0% were located in the lung left parenchyma, 80.3% presented a TNM stage I-II. Mitotic count was ≥2 per 10 high-power field (HPF) in 24.7%, necrosis in 13.0%. Median overall survival (OS) was 46.1 months (0.6-323), median progression-free survival (PFS) was 36.0 months (0.3-323). Female sex correlated with a more indolent disease (T1; N0; lower Ki67; lower mitotic count and the absence of necrosis). Left-sided primary tumors were associated with higher mitotic count and necrosis. At Cox-multivariate regression model, age, left-sided tumors, nodal (N) positive status and the diagnosis of AC resulted independent negative prognostic factors for PFS and OS. CONCLUSIONS This study highlights that laterality is an independent prognostic factors in Lu-NETs, with left tumors being less frequent but showing a worse prognosis than right ones. A wider spectrum of clinical and pathological prognostic factors, including TNM stage, age and laterality is suggested. These parameters could help clinicians to personalize the management of Lu-NET.
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Affiliation(s)
- Anna La Salvia
- Department of Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Irene Persano
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Monica Verrico
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Bassi
- Department of Thoracic Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Roberta Modica
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Isabella Zanata
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | | | - Elena Trevisi
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giulia Puliani
- Oncological Endocrinology Unit, Regina Elena National Cancer Institute, Rome, Italy
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Maria Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Elena Parlagreco
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Roberto Baldelli
- Endocrinology Unit, Department of Oncology and Medical Specialities, A.O. San Camillo-Forlanini, Rome, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Franz Sesti
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Paola Razzore
- Endocrinology Unit, Mauriziano Hospital, Turin, Italy
| | - Rossella Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy
| | | | - Francesco Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Marco Volante
- Department of Oncology, Pathology Unit of San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Carmen Romero
- Scientific Support, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Andrea Isidori
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Maria Rosaria Ambrosio
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea University Hospital, Rome, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Pia Brizzi
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy.
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Variabilitatea răspunsului la terapia multimodală într-un carcinoid bronşic în stadiul IV: un raport de caz. ONCOLOG-HEMATOLOG.RO 2022. [DOI: 10.26416/onhe.60.3.2022.7155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mégevand V, Lutz JA, Kocher GJ, Dumont P. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6535929. [PMID: 35211728 PMCID: PMC9336576 DOI: 10.1093/icvts/ivac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/12/2022] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vladimir Mégevand
- Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Corresponding author. Department of Surgery, Hôpitaux Universitaires de Genève, Université de Genève, CH - 1205 Geneva, Switzerland. Tel: +41-79-833-28-02; e-mail: (V. Mégevand)
| | - Jon A Lutz
- Thoracic Unit, Department of Surgery, Hôpital Cantonal de Fribourg, Fribourg, Switzerland
| | - Gregor J Kocher
- Division of General Thoracic Surgery, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Philippe Dumont
- Department of Internal Medicine and Pneumology, Hôpital Cantonal de Fribourg, Fribourg, Switzerland
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Biancosino C, Redwan B, Welker L, Nakashima M, Branscheid D, Koesek V, Diemel KD, Krüger M. Surgical Strategy and Clinical Outcome in Patients with Bronchial Carcinoids. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1374:17-25. [PMID: 34550557 DOI: 10.1007/5584_2021_668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Carcinoids are malignant neuroendocrine neoplasms showing good long-term survival after oncologic therapy. The study evaluated the influence of operative strategies and individual decision-making on the outcome and long-term survival in 222 patients with bronchial carcinoids. The patients underwent preoperative pulmonary function tests and bronchoscopy to facilitate surgical decision-making. A hundred and twelve tumors were detected endoscopically, including 32 in the main and lobar bronchi. We performed 5 isolated bronchus resections, 4 segmentectomies, 15 wedge resections, 10 pneumonectomies, 19 sleeve resections, 26 bilobectomies, 138 lobectomies, and 2 chest wall resections. Three patients were technically inoperable. Systematic mediastinal lymphadenectomy was routinely performed although most patients' computer tomography scans showed N0. A hundred and sixty-two patients had typical (155 N0, 7 N+) and 60 patients had atypical carcinoids (39 N0, 21 N+). There was no intraoperative mortality. The hospital mortality was below 2%. Overall, 1-, 5-, and 10-year survival rates were 99%, 94%, and 89%, respectively, in typical carcinoids. Atypical carcinoids show similar 1- and 5-year survival rates, but the 10-year survival rate was below 70%, decreasing in higher N-stages. The N-stage was the most important survival factor. In conclusion, bronchial carcinoids should be surgically treated the way lung cancer is. Anatomic resection and systematic lymphadenectomy are the treatments of choice. The availability of bronchoplastic techniques and preoperative assessment is essential for individual decision-making, focusing predominantly on postoperative quality of life.
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Affiliation(s)
- Christian Biancosino
- Department of Thoracic Surgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany.
| | - Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park Lünen, Lünen, Germany
| | - Lutz Welker
- LungClinic Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany
| | - Masaki Nakashima
- LungClinic Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany
| | - Detlef Branscheid
- LungClinic Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany
| | - Volkan Koesek
- Department of Thoracic Surgery, Klinik am Park Lünen, Lünen, Germany
| | | | - Marcus Krüger
- Department of Thoracic Surgery, Martha - Maria Hospital Halle - Dölau, Halle, Germany
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Zhang J, Yu Q, He Y, Hu T, Chen K, Yang Z, Zhang X, Cheng D, He Z. The Cancers-Specific Survival of Metastatic Pulmonary Carcinoids and Sites of Distant Metastasis: A Population-Based Study. Technol Cancer Res Treat 2021; 20:15330338211036528. [PMID: 34378452 PMCID: PMC8361524 DOI: 10.1177/15330338211036528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Lung cancer is the leading cause of cancer-related deaths and pulmonary carcinoids (PCs) account for almost 2% of all pulmonary malignancies. However, few published articles have reported prognosis and related factors of pulmonary carcinoid patients. Material and Method: The Surveillance, Epidemiology, and End Results (SEER) database was used to collect data of patients diagnosed with metastatic PCs from 2010 to 2016. The prognosis and survival of these patients were compared by employing Cox proportional hazards and the Kaplan-Meier survival analysis. Results: A total of 1763 patients were analyzed. The liver (668, 25.6%) was shown to be the most common metastatic site in the isolated organ metastasis cohort, followed by the lung (636, 24.4%), bone (562, 21.6%), and brain (460, 17.6%). Among the patients, the tumor metastasized to a single distant site included the liver, bone, lung, and brain. Cancer-specific survival (CSS) in metastatic PCs is determined by the site of metastasis and the total number of such sites. Pulmonary carcinoid patients with isolated liver metastasis manifested more favorable survival rates in comparison to patients having isolated metastasis in the lung, brain, or bone. The median CSS was 45, 7, 6, 5 months (P = 0.011). The number of distant metastatic sites and the location of distant metastasis were found to be independent risk factors for CSS. For patients with distant isolated metastasis, liver metastasis (P < 0.0001) had better CSS in comparison to those with bone metastasis. When compared to patients whose carcinoids had metastasized to the bones, patients with a brain (P = 0.273) or lung (P = 0.483) metastasis had the same CSS. Conclusion: Cancer-specific survival in metastatic PCs depends on the site of metastasis and the total number of such locations. PC patients with isolated liver metastasis manifested more favorable survival in comparison to patients with isolated metastasis in the lung, brain, or bone.
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Affiliation(s)
- Jiandong Zhang
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiongjie Yu
- Department of Chemoradiation Oncology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi He
- Department of Respiration, 223528Shaoxing Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Tingting Hu
- Department of Chemoradiation Oncology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kun Chen
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhihao Yang
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xingbo Zhang
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dezhi Cheng
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhifeng He
- Department of Thoracic Surgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Soldath P, Binderup T, Kjær A, Federspiel B, Langer SW, Knigge U, Petersen RH. Long-term survival and recurrence after resection of bronchopulmonary carcinoids: A single-center cohort study of 236 patients. Lung Cancer 2021; 156:109-116. [PMID: 33940543 DOI: 10.1016/j.lungcan.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to determine overall survival and recurrence-free survival after resection of bronchopulmonary carcinoids by means of predominantly minimally invasive surgery and lung-sparing resections. In addition, we aimed to identify prognostic factors for overall survival. MATERIALS AND METHODS Retrospective review of consecutive patients operated for bronchopulmonary carcinoids between January 2009 and October 2020 identified from a prospectively collected database. RESULTS A total of 236 patients representing 240 cases of bronchopulmonary carcinoids were included. Of these, 212 (88.3 %) were typical carcinoids, while 28 (11.7 %) were atypical carcinoids. A Video-Assisted Thoracoscopic Surgery (VATS) approach was used in 75 % of cases. There was no 30-day mortality. The median follow-up was 5.6 years for overall survival and 4.7 years for recurrence-free survival. 5- and 10-year overall survival rates were 89 % and 71 %, while 5- and 10-year recurrence-free survival rates were 84 % and 71 %. Patients with atypical carcinoids had significantly reduced overall survival and recurrence-free survival rates (HR 3.4; 95 % CI 1.5-7.6; p = 0.003 and HR 5.4; 95 % CI 2.6-11.4; p < 0.001). Independent predictors of overall survival included atypical carcinoid (HR 2.7; 95 % CI 1.2-6.0; p = 0.018) and age > 60 years (HR 2.9; 95 % CI 1.2-7.3; p = 0.021). CONCLUSION Surgery for bronchopulmonary carcinoids by means of predominantly VATS and lung-sparing resections provides favorable long-term survival. Atypical carcinoids and age > 60 years are independent predictors of poor overall survival.
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Affiliation(s)
- Patrick Soldath
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Tina Binderup
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark.
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark.
| | - Birgitte Federspiel
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark.
| | - Seppo W Langer
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Ulrich Knigge
- Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark.
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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13
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Thakur S, Florisson D, Telianidis S, Yaftian N, Lee J, Knight S, Barnett S, Seevanayagam S, Antippa P, Alam N, Wright G. Pulmonary carcinoid tumours: A multi-centre analysis of survival and predictors of outcome following sublobar, lobar, and extended pulmonary resections. Asian Cardiovasc Thorac Ann 2021; 29:532-540. [PMID: 33853389 DOI: 10.1177/02184923211010090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary carcinoids are rare neoplasms, accounting for approximately 1%-2% of all lung malignancies. A retrospective analysis was undertaken of all patients who underwent surgical resection of pulmonary carcinoid tumours across multiple institutions in Melbourne, Australia. METHODS From May 2000 through April 2020, 241 patients who underwent surgical resection of pulmonary carcinoid tumours were retrospectively reviewed. Patient demographics, pathologic data, and long-term outcomes were recorded. RESULTS Median age was 57.7 years and the majority of patients were female (58.9% vs. 41.1%). Typical carcinoid was present in 77.1%. Histological subtype was associated with several factors. Atypical carcinoid was more likely to have larger tumour size and nodal involvement. Overall survival for typical carcinoid at 5, 10, and 15 years was 98%, 95%, and 84%, and for atypical carcinoid was 88%, 82%, and 62%, respectively. Histological subtype and age were found to be independent predictors of overall survival, with worse outcomes for atypical and those above 60 years of age. Disease-free survival was related to sublobar resection (p < 0.001, sub-hazard ratio (SHR): 6.89), lymph node involvement (p = 0.022, SHR: 3.18), and atypical histology (p < 0.001, SHR: 9.89). CONCLUSION Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoids. Atypical histology and lymph node involvement are significant prognostic factors, and sublobar resection should not be considered in patients with either of the above features. Typical carcinoid tumour without nodal involvement may be appropriate for sublobar resection. Typical and atypical carcinoid tumours should be considered distinct disease entities, and as such treated accordingly.
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Affiliation(s)
- Sameer Thakur
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Daniel Florisson
- Department of Thoracic Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Stacy Telianidis
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Nima Yaftian
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jean Lee
- Department of Medical Imaging, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Simon Knight
- Department of Thoracic Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Stephen Barnett
- Department of Thoracic Surgery, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Siven Seevanayagam
- Department of Thoracic Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter McCallum Cancer Centre, Parkville, Victoria, Australia
| | - Naveed Alam
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Gavin Wright
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter McCallum Cancer Centre, Parkville, Victoria, Australia
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Diagnostic Yield and Bleeding Complications Associated With Bronchoscopic Biopsy of Endobronchial Carcinoid Tumors. J Bronchology Interv Pulmonol 2021; 27:184-189. [PMID: 31876538 DOI: 10.1097/lbr.0000000000000639] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bronchial carcinoid often appears hypervascular on bronchoscopic visualization and may be associated with hemoptysis. The diagnostic yield and bleeding complications associated with bronchoscopic biopsy of bronchial carcinoid tumors remain unclear. MATERIALS AND METHODS Patients with bronchial carcinoid tumors that were bronchoscopically visualized and biopsied at our tertiary referral medical center, over an 8-year period from 2010 to 2017, were retrospectively identified and reviewed to assess diagnostic yield and bleeding complications. Correlations with patient characteristics and carcinoid tumor features were analyzed. RESULTS Forty-nine patients were included (57% female). Tumors were predominantly (71%) located in proximal airways (mainstem and lobar bronchi). Bronchoscopic biopsy was diagnostic in 45 patients (92%). Thirteen patients (27%) experienced moderate (n=12, 25%) or severe (n=1, 2%) bleeding. Among these, 6 tumors (46%) had a vascular appearance and 4 patients (31%) had experienced recent hemoptysis. However, neither vascularity nor hemoptysis was associated with bleeding at biopsy (P=0.68 and 0.73, respectively). Carcinoid tumors were classified as typical in 79% and atypical in 21% with no difference in diagnostic yield or bleeding risk (P=0.28 and 0.92, respectively). Tumor size was also not associated with increased diagnostic yield or bleeding risk (P=0.54 and 0.39, respectively). CONCLUSION Bronchoscopic biopsy of endobronchial carcinoid is associated with a high diagnostic yield and severe bleeding is rarely encountered. Diagnostic yield and bleeding seemed independent of vascular tumor appearance or history of recent hemoptysis.
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Papaporfyriou A, Domayer J, Meilinger M, Firlinger I, Funk GC, Setinek U, Kostikas K, Valipour A. Bronchoscopic diagnosis and treatment of endobronchial carcinoid: case report and review of the literature. Eur Respir Rev 2021; 30:200115. [PMID: 33408086 PMCID: PMC9488937 DOI: 10.1183/16000617.0115-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/02/2020] [Indexed: 11/05/2022] Open
Abstract
Carcinoid tumours are rare neuroendocrine neoplasms that mostly occur in younger adults with low tendencies to metastasise. Based on their histological characteristics, they are divided into typical and atypical subtypes. The most common presenting symptoms are due to central airway obstruction. The first step in the diagnostic assessment should be a computed tomography (CT) scan, as it provides information both for local tumour extent and lymph node involvement. Bronchoscopy is the main tool for histological confirmation, evaluation of bronchial wall invasion and removal of endobronchial manifestation with subsequent resolution of atelectasis. Endobronchial ultrasound may be necessary to rule out lymph node metastasis. Somatostatin receptor scintigraphy in combination with CT can rule out further metastatic disease.Surgical resection using parenchyma-sparing techniques remains the gold standard for treatment. For selected patients, endobronchial therapy could be an alternative for minimal invasiveness. Long-term follow-up is suggested due to the high likelihood of recurrence.Here, we describe our clinical experience in a 35-year-old male patient who originally presented with haemoptysis and a central polypoid tumour in the left main bronchus revealed by a CT scan. The histological characteristics were indicative of a typical carcinoid. The patient was treated using an endobronchial approach only. No complications and no recurrences have been observed in a follow-up of 2 years.
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Affiliation(s)
- Anastasia Papaporfyriou
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
- Respiratory Medicine Dept, University of Ioannina Medical School, Ioannina, Greece
| | - Julian Domayer
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Michael Meilinger
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Irene Firlinger
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, 4 Medizinische Abteilung, Wilhelminenspital, Vienna, Austria
| | - Ulrike Setinek
- Institute for Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | | | - Arschang Valipour
- Dept of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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16
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Snene H, Badri I, Mehiri N, Ben Salah N, Blibech H, Aouina H, Belhadj S, Boussen H, Chaouch N, Charfi R, Fenniche S, Gharbi L, Ghrairi H, Hamzaoui A, Megdiche L, Merai S, Mezni F, Tritar F, Daghfous J, Marghli A, Louzir B. [Diagnostic and therapeutic management of operable bronchopulmonary carcinoid tumours]. Rev Mal Respir 2021; 38:249-256. [PMID: 33674138 DOI: 10.1016/j.rmr.2021.02.062] [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: 07/28/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bronchial carcinoid tumours (CT), divided into typical carcinoid (TC) or atypical carcinoid (AC), are rare tumours whose therapeutic management remains unspecified. METHODS Retrospective study collecting cases of bronchial CT operated at the thoracic surgery department of Abderrahmane-Mami hospital of Ariana and recruited from the pneumology departments of Northern Tunisia, during a 12-year period. RESULTS Ninety patients were collected (74 cases of TC and 16 cases of AC). The mean age was 45 years and the sex ratio H/F=0.5. The chest X-ray was normal in 11 cases, as well as flexible bronchoscopy in seven cases. The tumour was classified: stage IA (10 cases), IIA (28 cases), IIB (31 cases), IIIA (15 cases) and IIIB (six cases). Surgery resulted in a complete resection in 78 patients, an extensive resection in six patients, and a conservative resection in six patients. Adjuvant chemotherapy was given in 10 patients. The survival was 84% at five years and 42% at 10 years. CONCLUSION The prognosis of CT depends directly on the histological subtype. It is excellent for TC after complete resection, unlike ACs that are similar to well-differentiated bronchial carcinomas.
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Affiliation(s)
- H Snene
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie.
| | - I Badri
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - N Mehiri
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - N Ben Salah
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - H Blibech
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - H Aouina
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Charles-Nicolle, Tunis, Tunisie
| | - S Belhadj
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, hôpital régional de Menzel-Bourguiba, Bizerte, Tunisie
| | - H Boussen
- Faculté de médecine de Tunis, université de Tunis El Manar, service d'oncologie médicale, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - N Chaouch
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon 2, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - R Charfi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, hôpital des forces de sécurité intérieur, Tunis, Tunisie
| | - S Fenniche
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon 4, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - L Gharbi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon D, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - H Ghrairi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, hôpital Taher-Maamouri, Nabeul, Tunisie
| | - A Hamzaoui
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon B, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - L Megdiche
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon Ibn Nafis, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - S Merai
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, CHU La Rabta, Tunis, Tunisie
| | - F Mezni
- Faculté de médecine de Tunis, université de Tunis El Manar, service d'anatomie pathologie, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - F Tritar
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon C, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - J Daghfous
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - A Marghli
- Faculté de médecine de Tunis, université de Tunis El Manar, service de chirurgie thoracique et cardiovasculaire, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - B Louzir
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
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Bishnoi S, Asaf BB, Puri HV, Pulle MV, Gopinath SK, Sharma S, Patel MV, Kumar A. Endobronchial Carcinoids: Surgical Outcome in 100 Consecutive Patients and Factors Affecting Lung Preservation. Indian J Surg Oncol 2021; 12:190-198. [PMID: 33814853 PMCID: PMC7960861 DOI: 10.1007/s13193-020-01248-7] [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: 05/10/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Abstract
Bronchial carcinoids are slow-growing tumours of the neuroendocrine family. Most of them have a benign course with excellent outcome after complete resection. Due to their location in the primary bronchi, adequate resection with lung preservation requires considerable technical expertise. In this paper we present our surgical experience with endobronchial carcinoids and analyse the factors that predict possibility of lung preservation surgery. Retrospective analysis of a prospectively maintained database of patients operated for endobronchial carcinoids for the period March 2012 to September 2019 was carried out. Demographic factors and peri-operative variables were recorded and analysed. Factors that influence surgical outcome and possibility of lung preservation surgery were analysed. A total of 137 patients underwent surgery for resection of carcinoid tumours, out of which 100 had endobronchial carcinoids whereas 37 had peripheral carcinoids. The surgical procedure in 100 patients with endobronchial carcinoids included 14 left main bronchus sleeve resections, 13 pneumonectomies (7 right sided and 6 left sided), 10 right lower and middle bi-lobectomies, 10 lobectomies (4 left upper, 2 left lower and 4 right upper), and 53 sleeve lobectomies (18 left upper lobe sleeves, 8 left lower lobe sleeves, 20 right upper lobe sleeves, 5 right middle lobe sleeves and 2 right lower lobe sleeve lobectomies). There was no operative mortality. Median tumour size was 3.9 cm (range 5-130 mm). On univariate analysis, longer duration of symptoms was associated with poor surgical outcomes. On multivariate analysis, tumour in the main bronchus, duration of disease < 3 months (p = 0.006), left-sided disease (p = 0.03), and presence of healthy distal lung parenchyma (p < 0.001) were associated with successful lung preservation. Majority of endobronchial carcinoid tumours can be managed with lung-sparing procedures with minimal morbidity and mortality and excellent immediate and short-term outcomes. Early referral and experience of team performing these complex procedures are the key to success.
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Affiliation(s)
- Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Harsh Vardhan Puri
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | | | - Shikha Sharma
- Department of Anaesthesia, sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
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18
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Prinzi N, Rossi RE, Proto C, Leuzzi G, Raimondi A, Torchio M, Milione M, Corti F, Colombo E, Prisciandaro M, Cascella T, Spreafico C, Beninato T, Coppa J, Lo Russo G, Di Bartolomeo M, de Braud F, Pusceddu S. Recent Advances in the Management of Typical and Atypical Lung Carcinoids. Clin Lung Cancer 2020; 22:161-169. [PMID: 33618994 DOI: 10.1016/j.cllc.2020.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 11/17/2022]
Abstract
Neuroendocrine neoplasms of the lung represent about 20% to 30% of all neuroendocrine tumors. On the basis of clinical and pathologic characteristics, 2 different categories of tumors may be defined: poorly differentiated neuroendocrine neoplasms, characterized by a high rate of recurrences and poor prognosis, and well-differentiated neuroendocrine neoplasms (typical carcinoids and atypical carcinoids), which generally display an indolent course. Lung carcinoids represent only 1% to 5% of all lung malignancies, but their incidence has significantly increased over the past 30 years. Surgery is the reference standard of treatment for lung carcinoids with locoregional disease. For advanced or unresectable lung carcinoids, several therapeutic options are available, but the choice should be shared within a multidisciplinary team to ensure optimal therapeutic outcomes. We describe the current management of these rare neoplasms.
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Affiliation(s)
| | - Roberta Elisa Rossi
- Gastrointestinal Surgery and Liver Transplantation Unit; Department of Pathophysiology and Organ Transplant, Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | - Massimo Milione
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Tommaso Cascella
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Spreafico
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | - Filippo de Braud
- Department of Medical Oncology; Oncology and Hemato-oncology Department, Università degli Studi di Milano, Milan, Italy
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Therapeutic options in lung neuroendocrine tumors: between established concepts and new hopes. Anticancer Drugs 2020; 30:e0784. [PMID: 30896503 DOI: 10.1097/cad.0000000000000784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Typical (TC) and atypical (AC) carcinoids are low-grade neuroendocrine tumors (NETs) of the lung and, are neglected diseases in respect of both high-grade NETs of the lung (i.e. small-cell lung cancer and large-cell neuroendocrine carcinoma) and gastroenteropancreatic (GEP)-NETs. AC and TC account for 2 and 0.2% of all thoracic malignancies, respectively, and have a 12.9% chance of metastatic spread at diagnosis, reaching up to 20% during disease history. There are very few trials specifically designed for lung NETs, and therapeutic options are mainly derived by studies carried out in patients with GEP-NETs. We report a case of a patient affected by AC progressed to available standard treatments who received off-label treatment with sunitinib, a well-known multitarget tyrosine-kinase inhibitor with marked antiangiogenic activity, used routinely for the treatment of GEP-NETs. During treatment, the patient required the administration of an alternative schedule to improve tolerability, with benefit, and achieved a partial response according to the RECIST criteria, which is unusual in NETs. We critically reviewed available data supporting the use of somatostatin analogs, chemotherapy, and target therapies (everolimus and sunitinib) in advanced lung NETs. In the review, ongoing trials in lung NETs and future developments in this research field are also discussed.
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Georgakopoulou VE, Zygouris E, Nikokiris C, Damaskos C, Pierrakou A, Garmpis N, Garmpi A, Sklapani P, Aravantinou A, Trakas N, Janinis J, Dahabreh J. Predictive Indicators of Survival in Patients With Surgically Resected Lung Carcinoid Tumors at a Greek Medical Center. Cureus 2020; 12:e10300. [PMID: 32923302 PMCID: PMC7478793 DOI: 10.7759/cureus.10300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Lung carcinoid tumors are neuroendocrine neoplasms, less frequent than other lung tumors. They are subdivided into typical carcinoids (TC) and atypical carcinoids (AC), according to the rate of mitosis and the presence of necrosis. Lung carcinoids are often asymptomatic and only discovered incidentally. They may also present with cough, wheezing, asthma, and chronic obstructive pulmonary disease, chest pain, and hemoptysis depending on the location of the tumor and, less commonly, present with carcinoid syndrome. In our study, we describe the clinical and pathological features of patients with surgically resected lung carcinoids at our institution over a period of 14 years. We also examine if these features, including age, gender, tumor size, type of carcinoid, stage, nodal involvement, and Ki-67 expression are associated with patients' survival. Materials and methods We retrospectively reviewed patients that underwent surgery with a final histologic diagnosis of a pulmonary carcinoid tumor from March 2005 to March 2019. The evaluation included history, physical examination, chest radiographs, computerized tomography of the chest, upper abdomen, and brain, and bone scintiscan. All specimens resected during the surgical procedures were sent for pathological examination, including mediastinal and hilar lymph nodes. The patients' age, gender, tumor size, type of carcinoid, nodal involvement, stage, and Ki-67 expression were recorded and correlated to the patients' survival rates. Results The study included 108 patients - 52 males and 56 females - with a mean age of 51.5 years (range 11-80 years). Atypical carcinoid was the diagnosis in 28 patients (16 males and 12 females) and 80 patients had the diagnosis of typical carcinoid (36 males and 44 females). Tumor size was ≤3.7 cm in 84 patients (68 with TC and 16 with AC) and >3.7 cm in 22 patients (12 with TC and 10 with AC). Sixteen patients had nodal deposits, 12 in N1 nodes and four in N2 nodes. Eighty patients were classified in stage I, 18 patients in stage II, and 10 patients in stage III. None of the patients had distant metastases. The Ki-67 proliferation index was examined in 84 specimens and Ki-67 was <2.5 in 50 patients and ≥2.5 in 34 patients. Of the 108 patients, eight died, all with disease-related death. According to the Cox regression univariate analysis, four factors were correlated to shorter survival: atypical histology, tumor size >3.7 cm, nodal involvement, and advanced stage Conclusions In conclusion, we found that histological type, tumor size, nodal involvement, and stage are associated with survival in patients with surgically resected lung carcinoids without distant metastases. Other parameters, such as age at operation, gender, and Ki-67 index, did not have a role in survival in these patients according to the Cox regression univariate analysis.
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Affiliation(s)
- Vasiliki E Georgakopoulou
- Pulmonology Department, Laiko General Hospital, Athens, GRC.,1st Pulmonology Department, Sismanogleio Hospital, Athens, GRC
| | | | | | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | | | | | | | - Jim Janinis
- Oncology, Athens Medical Center, Athens, GRC
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Dong S, Liang J, Zhai W, Yu Z. Development and Validation of an Individualized Nomogram for Predicting Overall Survival in Patients With Typical Lung Carcinoid Tumors. Am J Clin Oncol 2020; 43:607-614. [PMID: 32889829 PMCID: PMC7515482 DOI: 10.1097/coc.0000000000000715] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We aim to develop and validate an effective nomogram prognostic model for patients with typical lung carcinoid tumors using a large patient cohort from the Surveillance, Epidemiology, and End Results (SEER) database. MATERIALS AND METHODS Data from patients with typical lung carcinoid tumors between 2010 and 2015 were selected from the SEER database for retrospective analysis. Univariate and multivariate Cox analysis was performed to clarify independent prognostic factors. Next, a nomogram was formulated to predict the probability of 3- and 5-year overall survival (OS). Concordance indexes (c-index), receiver operating characteristic analysis and calibration curves were used to evaluate the model. RESULTS The selected patients were randomly divided into a training and a validation cohort. A nomogram was established based on the training cohort. Cox analysis results indicated that age, sex, T stage, N stage, surgery, and bone metastasis were independent variables for OS. All these factors, except surgery, were included in the nomogram model for predicting 3- and 5-year OS. The internally and externally validated c-indexes were 0.787 and 0.817, respectively. For the 3-year survival prediction, receiver operating characteristic analysis showed that the areas under the curve in the training and validation cohorts were 0.824 and 0.795, respectively. For the 5-year survival prediction, the area under the curve in the training and validation cohorts were 0.812 and 0.787, respectively. The calibration plots for probability of survival were in good agreement. CONCLUSION The nomogram brings us closer to personalized medicine and the maximization of predictive accuracy in the prediction of OS in patients with typical lung carcinoid tumors.
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Affiliation(s)
- Shenghua Dong
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Wenxin Zhai
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province
| | - Zhuang Yu
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province
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22
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Huge typical pulmonary carcinoid presented with gigantism syndrome. Gen Thorac Cardiovasc Surg 2020; 69:371-374. [PMID: 32725474 PMCID: PMC7868318 DOI: 10.1007/s11748-020-01445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/17/2020] [Indexed: 11/07/2022]
Abstract
A 27-year-old male patient presented with cough and right-sided, light thoracic pain. His physical appearance showed typical features of gigantism. Subsequently, further diagnostic work-up showed elevated level of growth hormone and a huge tumor of the right lung, identifying a typical pulmonary carcinoid tumor (TPCT). Curative surgery was performed leading to normalization of the elevated growth hormone levels few days after surgery. Two- and five-year follow-up showed no signs of recurrence. Respected to tumor size, we determined the largest TPCT to be reported in medical literature history.
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23
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Singh S, Bergsland EK, Card CM, Hope TA, Kunz PL, Laidley DT, Lawrence B, Leyden S, Metz DC, Michael M, Modahl LE, Myrehaug S, Padda SK, Pommier RF, Ramirez RA, Soulen M, Strosberg J, Sung A, Thawer A, Wei B, Xu B, Segelov E. 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; 15:1577-1598. [PMID: 32663527 DOI: 10.1016/j.jtho.2020.06.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 06/14/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022]
Abstract
Lung neuroendocrine tumors (LNETs) are uncommon cancers, and there is a paucity of randomized evidence to guide practice. As a result, current guidelines from different neuroendocrine tumor societies vary considerably. There is a need to update and harmonize global consensus guidelines. This article reports the best practice guidelines produced by a collaboration between the Commonwealth Neuroendocrine Tumour Research Collaboration and the North American Neuroendocrine Tumor Society. We performed a formal endorsement and updating process of the 2015 European Neuroendocrine Tumor Society expert consensus article on LNET. A systematic review from January 2013 to October 2017 was conducted to procure the most recent evidence. The stepwise endorsement process involved experts from all major subspecialties, patients, and advocates. Guided by discussion of the most recent evidence, each statement from the European Neuroendocrine Tumor Society was either endorsed, modified, or removed. New consensus statements were added if appropriate. The search yielded 1109 new publications, of which 230 met the inclusion criteria. A total of 12 statements were endorsed, 22 statements were modified or updated, one was removed, and two were added. Critical answered questions for each topic in LNET were identified. Through the consensus process, guidelines for the management of patients with local and metastatic neuroendocrine tumors have been updated to include both recent evidence and practice changes relating to technological and definitional advances. The guidelines provide clear, evidence-based statements aimed at harmonizing the global approach to patients with LNETs, on the basis of the principles of person-centered and LNET-specific care. The importance of LNET-directed research and person-centered care throughout the diagnosis, treatment, and follow-up journey is emphasized along with directions for future collaborative research.
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Affiliation(s)
- Simron Singh
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Emily K Bergsland
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, San Francisco, California
| | | | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, Division of Hematology/Oncology, University of California, San Francisco, San Francisco, California
| | - Pamela L Kunz
- Department of Medicine, Yale University, New Haven, Connecticut
| | - David T Laidley
- Department of Medical Imaging, Division of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ben Lawrence
- Discipline of Oncology, University of Auckland, Auckland, New Zealand
| | - Simone Leyden
- Unicorn Foundation, Blairgowrie, Victoria, Australia
| | - David C Metz
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Michael
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy E Modahl
- Auckland Radiology Group, Auckland City Hospital, Auckland, New Zealand
| | - Sten Myrehaug
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sukhmani K Padda
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | | | - Robert A Ramirez
- Department of Medical Oncology, Ochsner Medical Center, New Orleans, Louisiana
| | - Michael Soulen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Arthur Sung
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, California
| | - Alia Thawer
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Benjamin Wei
- Department of Surgery, Birmingham Medical Center, University of Alabama, Birmingham, Alabama
| | - Bin Xu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eva Segelov
- Department of Oncology, Monash Health, Monash University, Melbourne, Victoria, Australia
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24
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Moran CA, Lindholm KE, Brunnström H, Langman G, Jang SJ, Spagnolo D, Chai SM, Laycock A, Falconieri G, Pizzolitto S, de Pellegrin A, Medeiros F, Edmunds L, Catarino A, Cunha F, Ro J, Pina-Oviedo S, Torrealba J, Coppola D, Petersson F, Oon ML, Elmberger G, Y Cajal SR, Valero IS, Dalurzo L, Soares F, Campos AH, Vranic S, Skenderi F, Correa AM, Sepesi B, Rice D, Mehran R, Walsh G. Typical and atypical carcinoid tumors of the lung: a clinicopathological correlation of 783 cases with emphasis on histological features. Hum Pathol 2020; 98:98-109. [PMID: 32145220 DOI: 10.1016/j.humpath.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 11/17/2022]
Abstract
We present 783 surgical resections of typical and atypical carcinoid tumors of the lung identified in the pathology files of 20 different pathology departments. All cases were critically reviewed for clinical and pathological features and further correlated with clinical outcomes. Long-term follow-up was obtained in all the patients and statistically analyzed to determine significance of the different parameters evaluated. Of the histopathological features analyzed, the presence of mitotic activity of 4 mitoses or more per 2 mm2, necrosis, lymphatic invasion, and lymph node metastasis were identified as statistically significant. Tumors measuring 3 cm or more were also identified as statistically significant and correlated with clinical outcomes. Based on our analysis, we consider that the separation of low- and intermediate-grade neuroendocrine neoplasms of the lung needs to be readjusted in terms of mitotic count as the risk of overgrading these neoplasms exceeds 10% under the current criteria. We also consider that tumor size is an important feature to be considered in the assessment of these neoplasms and together with the histological grade of the tumor offers important features that can be correlated with clinical outcomes.
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Affiliation(s)
- Cesar A Moran
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Kaleigh E Lindholm
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Hans Brunnström
- Lund University, Laboratory Medicine, Department of Clinical Sciences Lund, Pathology, Lund, 22210, Sweden
| | - Gerald Langman
- Heart of England NHS Foundation Trust, Birmingham, B1 1BB, United Kingdom
| | - Se Jin Jang
- Asan Medical Center, Ulsan University School of Medicine, Seoul, 100-011, Republic of Korea
| | - Dominic Spagnolo
- PathWest Laboratory Medicine Western Australia, University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, Western Australia, 6006, Australia; University of Notre Dame, Fremantle, Western Australia, 6006, Australia
| | - Siaw Ming Chai
- PathWest Laboratory Medicine Western Australia, University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, Western Australia, 6006, Australia
| | - Andrew Laycock
- PathWest Laboratory Medicine Western Australia, University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, Western Australia, 6006, Australia; University of Notre Dame, Fremantle, Western Australia, 6006, Australia
| | | | | | | | - Filomena Medeiros
- Essex Cardiothoracic Center, Basildon, CB1 6NU, United Kingdom; Thurrock University Hospitals NHS Foundation Trust, RM16 4XS, United Kingdom
| | - Lilian Edmunds
- Essex Cardiothoracic Center, Basildon, CB1 6NU, United Kingdom; Thurrock University Hospitals NHS Foundation Trust, RM16 4XS, United Kingdom
| | | | | | - Jae Ro
- Methodist Hospital, Houston, TX, 77030, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Arlene M Correa
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
| | - Boris Sepesi
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
| | - David Rice
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
| | - Reza Mehran
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
| | - Garrett Walsh
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
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25
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Rizk A, Salam MA, Elnahas E, Fekry H, Salem M, Magdy M, Zidan M, Nosseir A, Eldowik Y, Kotb A, Mahmoud MI, Elmallawany H. Bronchoscopic management of endobronchial carcinoid presenting as asthma Mimic. Respir Med Case Rep 2020; 29:101020. [PMID: 32140402 PMCID: PMC7044744 DOI: 10.1016/j.rmcr.2020.101020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022] Open
Abstract
We report a 25-year-old woman with persistent dyspnea and wheezes that had been unsuccessfully treated with inhaled beta 2-agonists and steroids for about one year. Spirometry demonstrated a restrictive pattern. Chest CT demonstrated polypoidal lesion in left main bronchus. The lesion was excised via rigid bronchoscopy. Pathology showed a picture of typical bronchial carcinoid. In this patient, due to the lack of awareness, diagnosis of carcinoid was delayed for one year.
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Affiliation(s)
- Ayman Rizk
- Interventional Pulmonology Unit of Alexandria Police Hospital, Egypt
| | - Mohamed A Salam
- Interventional Pulmonology Unit of Alexandria Police Hospital, Egypt
| | - Engy Elnahas
- Interventional Pulmonology Unit of Alexandria Police Hospital, Egypt
| | - Hasnaa Fekry
- Interventional Pulmonology Unit of Alexandria Police Hospital, Egypt
| | - Mohamed Salem
- Interventional Pulmonology Unit of Alexandria Police Hospital, Egypt
| | - Marwa Magdy
- Interventional Pulmonology Unit of Alexandria Police Hospital, Egypt
| | - Mohamed Zidan
- Chest Department of University Hospital of Alexandria, Egypt
| | - Ayman Nosseir
- Thoracic Surgery Department University Hospital of Alexandria, Egypt
| | - Yasser Eldowik
- Pathology Department, Faculty of Medicine, Al-Azhar University, Egypt
| | - Adel Kotb
- Chest Department of University Hospital of Alexandria, Egypt
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26
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Issoufou I, El Alami H, Belliraj L, Harmouchi H, Ammor FZ, Lakranbi M, Ouadnouni Y, Smahi M. [Surgery of tracheobronchial carcinoid tumours: Activity report]. Rev Mal Respir 2020; 37:117-122. [PMID: 31980232 DOI: 10.1016/j.rmr.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 08/01/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Our purpose is to evaluate our results of surgery for tracheobronchial carcinoid tumour as well as the long-term survival. METHODS This is a retrospective and descriptive study performed in the department of thoracic surgery of CHU Hassan II (Marocco) over a period of 9 years. It concerns all patients with a tracheal or bronchial carcinoid tumour who underwent surgery. RESULTS Twenty-three patients with a mean age of 39 years were operated on for 24 carcinoid tumours. The sex ratio was 0.29. The diagnostic delay ranged from 3 months to 8 years and the main symptom was haemoptysis in 74% of cases (n=17). The tumour was localized in the right bronchial tree in 70% of cases (n=16). The procedures performed were tracheal resection and end-to-end anastomosis in 1 case, lobectomy in 12 cases including 3 sleeve lobectomies, bilobectomy of middle and lower lobes in 7 cases and pneumonectomy in 4 cases. The prognosis was favourable in 91% after an average follow-up of 29 months. CONCLUSIONS Surgery remains the only curative therapeutic option for tracheobronchial carcinoid tumours with acceptable morbidity and mortality.
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Affiliation(s)
- I Issoufou
- Service de chirurgie thoracique, CHU Hassan II, route de Sidi-Harazem, BP 1893, Km 2,200, 30000 Fès Maroc.
| | - H El Alami
- Service de chirurgie thoracique, CHU Hassan II, route de Sidi-Harazem, BP 1893, Km 2,200, 30000 Fès Maroc
| | - L Belliraj
- Service de chirurgie thoracique, CHU Hassan II, route de Sidi-Harazem, BP 1893, Km 2,200, 30000 Fès Maroc
| | - H Harmouchi
- Service de chirurgie thoracique, CHU Hassan II, route de Sidi-Harazem, BP 1893, Km 2,200, 30000 Fès Maroc
| | - F Z Ammor
- Service de chirurgie thoracique, CHU Hassan II, route de Sidi-Harazem, BP 1893, Km 2,200, 30000 Fès Maroc
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, route de Sidi-Harazem, BP 1893, Km 2,200, 30000 Fès Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, route de Sidi-Harazem, BP 1893, Km 2,200, 30000 Fès Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, route de Sidi-Harazem, BP 1893, Km 2,200, 30000 Fès Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
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27
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Malczewska A, Kidd M, Matar S, Kos-Kudła B, Bodei L, Oberg K, Modlin IM. An Assessment of Circulating Chromogranin A as a Biomarker of Bronchopulmonary Neuroendocrine Neoplasia: A Systematic Review and Meta-Analysis. Neuroendocrinology 2020; 110:198-216. [PMID: 31266019 DOI: 10.1159/000500525] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/23/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Management of bronchopulmonary neuroendocrine neoplasia (NEN; pulmonary carcinoids [PCs], small-cell lung cancer [SCLC], and large cell neuroendocrine carcinoma) is hampered by the paucity of biomarkers. Chromogranin A (CgA), the default neuroendocrine tumor biomarker, has undergone wide assessment in gastroenteropancreatic neuroendocrine tumors. OBJECTIVES To evaluate CgA in lung NEN, define its clinical utility as a biomarker, assess its diagnostic, prognostic, and predictive efficacy, as well as its accuracy in the identification of disease recurrence. METHODS A systematic review of PubMed was undertaken using the preferred reporting items for systematic reviews and meta-analyses guidelines. No language restrictions were applied. Overall, 33 original scientific papers and 3 case reports, which met inclusion criteria, were included in qualitative analysis, and meta-analysis thereafter. All studies, except 2, were retrospective. Meta-analysis statistical assessment by generic inverse variance methodology. RESULTS Ten different CgA assay types were reported, without consistency in the upper limit of normal (ULN). For PCs (n = 16 studies; median patient inclusion 21 [range 1-200, total: 591 patients]), the CgA diagnostic sensitivity was 34.5 ± 2.7% with a specificity of 93.8 ± 4.7. CgA metrics were not available separately for typical or atypical carcinoids. CgA >100 ng/mL (2.7 × ULN) and >600 ng/mL (ULN unspecified) were anecdotally prognostic for overall survival (n = 2 retrospective studies). No evidence was presented for predicting treatment response or identifying post-surgery residual disease. For SCLC (n = 19 studies; median patient inclusion 23 [range 5-251, total: 1,241 patients]), the mean diagnostic sensitivity was 59.9 ± 6.8% and specificity 79.4 ± 3.1. Extensive disease typically exhibited higher CgA levels (diagnostic accuracy: 61 ± 2.5%). An elevated CgA was prognostic for overall survival (n = 4 retrospective studies). No prospective studies evaluating predictive benefit or prognostic utility were identified. CONCLUSION The available data are scarce. An assessment of all published data showed that CgA exhibits major limitations as an effective and accurate biomarker for either PC or SCLC. Its utility especially for localized PC/limited SCLC (when surgery is potentially curative), is limited. The clinical value of CgA remains to be determined. This requires validated, well-constructed, multicenter, prospective, randomized studies. An assessment of all published data indicates that CgA does not exhibit the minimum required metrics to function as a clinically useful biomarker for lung NENs.
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Affiliation(s)
- Anna Malczewska
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland
| | - Mark Kidd
- Wren Laboratories, Branford, Connecticut, USA
| | - Somer Matar
- Wren Laboratories, Branford, Connecticut, USA
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland
| | - Lisa Bodei
- Memorial Sloan Kettering Cancer Centre, New York, New York, USA
| | - Kjell Oberg
- Department of Endocrine Oncology, University Hospital, Uppsala, Sweden
| | - Irvin M Modlin
- Yale University School of Medicine, New Haven, Connecticut, USA,
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Windmöller BA, Greiner JF, Förster C, Wilkens L, Mertzlufft F, Esch JSA, Kaltschmidt B, Kaltschmidt C, Beshay M. A typical carcinoid of the lung - a case report with pathological correlation and propagation of the cancer stem cell line BKZ1 with synaptophysin expression. Medicine (Baltimore) 2019; 98:e18174. [PMID: 31804333 PMCID: PMC6919531 DOI: 10.1097/md.0000000000018174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Neuroendocrine tumors (NETs) of the lung account for 5% of all cases of lung cancer, which itself is the leading cause of cancer-related death worldwide. In accordance to its rarity, only few cell lines of NETs exist, which even often lack key characteristics of the primary tumor, making it difficult to study underlying molecular mechanisms. PATIENT CONCERNS The patient reported in this case is a 71-year old woman, which never smoked but suffered under dry cough. DIAGNOSES Chest CT-scan showed a paracardiac nodule of the lingula with 2 × 1.8 cm in diameter. INTERVENTIONS The detected paracardiac nodule of the lingula was anatomically resected using video assisted thoracic surgery. OUTCOMES Histopathological diagnostic of the removed tissue identified the tumor as a well-differentiated typical carcinoid (TC), which represents one of the four subgroups of pulmonary NETs. Next to the successful treatment of the patient, we were able to propagate cancer stem cells (CSCs) out of the resected tumor tissue. To the best of our knowledge, we firstly isolated CSCs of a typical carcinoid, which were positive for the prominent CSC markers CD44, CD133 and nestin, confirming their stem cell properties. Additionally, CSCs, further referred as BKZ1, expressed the neuroendocrine marker synaptophysin, verifying their neuroendocrine origin. However, nuclear synaptophysin protein was also present in other stem cell populations, suggesting a role as general stem cell marker. LESSON In line with the importance of CSCs in cancer treatment and the lack of CSC-models for neuroendocrine neoplasms, the here described BKZ1 cancer stem cell line of a typical carcinoid represents a promising new model to study pulmonary carcinoids and particular NETs.
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Affiliation(s)
- Beatrice Ariane Windmöller
- Department of Cell Biology, University of Bielefeld, Universitätsstrasse 25, Bielefeld
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
| | - Johannes F.W. Greiner
- Department of Cell Biology, University of Bielefeld, Universitätsstrasse 25, Bielefeld
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
| | - Christine Förster
- Institute of Pathology, KRH Hospital Nordstadt, Haltenhoffstrasse 41, Hannover
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
| | - Ludwig Wilkens
- Institute of Pathology, KRH Hospital Nordstadt, Haltenhoffstrasse 41, Hannover
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
| | - Fritz Mertzlufft
- Protestant Hospital of Bethel Foundation, Maraweg 21
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
| | - Jan Schulte am Esch
- Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation, Schildescher Strasse 99
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
| | - Barbara Kaltschmidt
- Department of Cell Biology, University of Bielefeld, Universitätsstrasse 25, Bielefeld
- Molecular Neurobiology, University of Bielefeld, Universitätsstrasse 25
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
| | - Christian Kaltschmidt
- Department of Cell Biology, University of Bielefeld, Universitätsstrasse 25, Bielefeld
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
| | - Morris Beshay
- Department of General Thoracic Surgery, Protestant Hospital of Bethel Foundation, Burgsteig 13
- Forschungsverbund BioMedizin Bielefeld, FBMB, Maraweg 21, Bielefeld, Germany
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Petursdottir A, Sigurdardottir J, Fridriksson BM, Johnsen A, Isaksson HJ, Hardardottir H, Jonsson S, Gudbjartsson T. Pulmonary carcinoid tumours: incidence, histology, and surgical outcome. A population-based study. Gen Thorac Cardiovasc Surg 2019; 68:523-529. [DOI: 10.1007/s11748-019-01261-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/22/2019] [Indexed: 12/17/2022]
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30
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Liao Y, Wang X, Zhong P, Yin G, Fan X, Huang C. A nomogram for the prediction of overall survival in patients with stage II and III non-small cell lung cancer using a population-based study. Oncol Lett 2019; 18:5905-5916. [PMID: 31788064 PMCID: PMC6865638 DOI: 10.3892/ol.2019.10977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 09/17/2019] [Indexed: 12/24/2022] Open
Abstract
As a malignant tumor with poor prognosis, accurate and effective treatment of non-small cell lung cancer (NSCLC) is crucial. To predict overall survival in patients with stage II and III NSCLC, a nomogram was constructed using data from the Surveillance, Epidemiology and End Results database. Eligible patients with NSCLC with available clinical information diagnosed between January 1, 2010 and November 31, 2015 were selected from the database, and the data were randomly divided into a training set and a validation set. Univariate and multivariate Cox regression analyses were used to identify prognostic factors with a threshold of P<0.05, and a nomogram was constructed. Harrell's concordance indexes and calibration plots were used to verify the predictive power of the model. Risk group stratification by stage was also performed. A total of 15,344 patients with stage II and III NSCLC were included in the study. The 3- and 5-year survival rates were 0.382 and 0.278, respectively. The training and validation sets comprised 10,744 and 4,600 patients, respectively. Age, sex, race, marital status, histology, grade, Tumor-Node-Metastasis T and N stage, surgery type, extent of lymph node dissection, radiation therapy and chemotherapy were identified as prognostic factors for the construction of the nomogram. The nomogram exhibited a clinical predictive ability of 0.719 (95% CI, 0.718–0.719) in the training set and 0.721 (95% CI, 0.720–0.722) in the validation set. The predicted calibration curve was similar to the standard curve. In addition, the nomogram was able to divide the patients into groups according to stage IIA, IIB, IIIA, and IIIB NSCLC. Thus, the nomogram provided predictive results for stage II and III NSCLC patients and accurately determined the 3- and 5-year overall survival of patients.
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Affiliation(s)
- Yi Liao
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xue Wang
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Ping Zhong
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Guofang Yin
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xianming Fan
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Chengliang Huang
- Department of Respiratory and Critical Care Medicine II, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Piro R, Tonelli R, Taddei S, Marchioni A, Musci G, Clini E, Facciolongo N. Atypical diagnosis for typical lung carcinoid. BMC Pulm Med 2019; 19:168. [PMID: 31477066 PMCID: PMC6719370 DOI: 10.1186/s12890-019-0929-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022] Open
Abstract
Background The diagnosis of lung typical carcinoid tumors results challenging when limited size and unfavorable sampling location is associated. It has been reported that bronchoscopy with endobronchial ultrasound (EBUS) significantly increases the diagnostic yield of peripheral nodules smaller than 2 cm. Case presentation A 70-year-old Caucasian male complained of persistent fever and cough despite several antibiotic courses and steroid treatment. Chest radiology revealed the presence of a small single nodular opacity in the left upper lobe, whose standardized maximum uptake value (SUV) at fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) was significantly high (4.5). The patient underwent bronchial endoscopy but any appreciable sign of endobronchial or intramural involvement was detected. Only radial ultrasound-guided bronchoscopy (R-EBUS) allowed transbronchial sampling whose pathological analysis revealed a typical carcinoid tumor. The patients underwent surgical lobectomy and clinic-radiological follow was started. Conclusions With this case we aim at stressing the importance of ultrasound in the diagnostic process of lung small peripheral carcinoid, especially if they present without mucosal or sub mucosal involvement.
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Affiliation(s)
- Roberto Piro
- Respiratory Diseases Unit, Azienda Unità Sanitaria Locale - IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Roberto Tonelli
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Sofia Taddei
- Respiratory Diseases Unit, Azienda Unità Sanitaria Locale - IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - Alessandro Marchioni
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Giovanni Musci
- Pathology Unit Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Clini
- Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Nicola Facciolongo
- Respiratory Diseases Unit, Azienda Unità Sanitaria Locale - IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
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Reuling EMBP, Dickhoff C, Plaisier PW, Bonjer HJ, Daniels JMA. Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review. Lung Cancer 2019; 134:85-95. [PMID: 31320001 DOI: 10.1016/j.lungcan.2019.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/31/2019] [Accepted: 04/08/2019] [Indexed: 12/26/2022]
Abstract
The treatment of pulmonary carcinoid has changed over the last decades. Although surgical resection is still the gold standard, minimally invasive endobronchial procedures have emerged as a parenchyma sparing alternative for tumors located in the central airways. This review was performed to identify the optimal treatment strategy for pulmonary carcinoid, with a particular focus on the feasibility and outcome of parenchyma sparing techniques versus surgical resection. A systematic review of the literature was carried out using MEDLINE, Embase and the Cochrane databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two separate searches of publications in endobronchial and surgical treatment in patients with pulmonary carcinoid, were performed. Outcomes were overall survival, disease free survival, recurrence rate, complications, quality of life, and healthcare costs. Combining the two main searches for endobronchial therapy and surgical therapy yielded 3111 records. Finally, 43 studies concerning surgical treatment and 9 studies related to endobronchial treatment for pulmonary carcinoid were included. Assessment of included studies showed that lymph node involvement, histological grade, tumor location and tumor diameter were identified as poor prognostic factors and seem to be important for patients with pulmonary carcinoid. For patients with a more favorable prognosis, tumor location and tumor diameter are important factors that can help decide on the optimal treatment strategy. Centrally located small intraluminal pulmonary carcinoids, without signs of metastasis can be treated with minimally invasive alternatives such as endobronchial treatment or parenchyma sparing surgical resection. Patients with parenchyma sparing resections should be followed with long term follow up to exclude recurrence of disease. In a multidisciplinary setting, it should be determined whether individual patients are eligible for parenchyma sparing procedures or anatomical resection. Overall evidence is of low quality and future studies should focus on prospective trials in the treatment of pulmonary carcinoid.
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Affiliation(s)
- E M B P Reuling
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands; Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands.
| | - C Dickhoff
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
| | - P W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands
| | - H J Bonjer
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
| | - J M A Daniels
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
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Differential Diagnosis of Asthma. ALLERGY AND ASTHMA 2019. [PMCID: PMC7123211 DOI: 10.1007/978-3-030-05147-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Asthma is one of the most common chronic syndromes worldwide (Moorman et al., Vital Health Stat 3(35), 2012). It is not a diagnosis but a clinical syndrome based on a constellation of signs and symptoms (Li et al., Ann Allergy Asthma Immunol 81:415–420(IIa), 1998). The classic symptoms of asthma include chest tightness, wheeze, cough, and dyspnea (Moorman et al., Vital Health Stat 3(35), 2012). The term asthma encompasses a spectrum of pulmonary diseases sharing the hallmark of reversible airway obstruction and can be classified as allergic or non-allergic (Löwhagen, J Asthma. 52(6):538–44, 2015). Asthma designated allergic is due to an immunoglobulin E (IgE)-mediated process, but as noted not all asthma is allergic in etiology (Romanet-Manent et al., Allergy 57:607–13, 2002). The differential diagnosis for asthma is broad and requires a detailed history with supportive pulmonary function tests to be properly diagnosed.
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Gosain R, Mukherjee S, Yendamuri SS, Iyer R. Management of Typical and Atypical Pulmonary Carcinoids Based on Different Established Guidelines. Cancers (Basel) 2018; 10:E510. [PMID: 30545054 PMCID: PMC6315766 DOI: 10.3390/cancers10120510] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022] Open
Abstract
Neuroendocrine tumors (NETs) are a group of malignancies that originated from neuroendocrine cells, with the most common sites being lungs and the gastrointestinal tract. Lung NETs comprise 25% of all lung malignancies. Small cell lung cancer is the most common form of lung NETs, and other rare forms include well-differentiated typical carcinoids (TCs) and poorly differentiated atypical carcinoids (ACs). Given the paucity of randomized studies, rational treatment is challenging. Therefore, it is recommended that these decisions be made using a multidisciplinary collaborative approach. Surgery remains the mainstay of treatment, when feasible. Following surgery, various guidelines offer different recommendations in the adjuvant setting. In this paper, we describe the adjuvant management of lung NETs, as recommended by different guidelines, and highlight their differences. In addition to that, we also discuss the management of metastatic lung NETS, including the use of peptide receptor radionucleotide therapy.
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Affiliation(s)
- Rohit Gosain
- Division of Hematology & Oncology, Roswell Park Comprehensive Cancer Center, University at Buffalo School of Medicine, Buffalo, NY 14203, USA.
| | - Sarbajit Mukherjee
- Division of Hematology & Oncology, Roswell Park Comprehensive Cancer Center, University at Buffalo School of Medicine, Buffalo, NY 14203, USA.
- Division of Hematology & Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - Sai S Yendamuri
- Depart of Thoracic Surgery Oncology, Roswell Park Comprehensive Cancer Center, University at Buffalo School of Medicine, Buffalo, NY 14203, USA.
| | - Renuka Iyer
- Division of Hematology & Oncology, Roswell Park Comprehensive Cancer Center, University at Buffalo School of Medicine, Buffalo, NY 14203, USA.
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Nodal involvement adversely affects prognosis in pulmonary carcinoid tumors. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:458-463. [PMID: 32082778 DOI: 10.5606/tgkdc.dergisi.2018.15566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/04/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to analyze the prognostic factors affecting survival in pulmonary carcinoid tumors. Methods Gender, age, smoking habit, comorbidity, localization of the tumor, T status, N status, histological type, and pathological stage of patients who had undergone resection of pulmonary carcinoid tumor between January 1, 2005 and December 31, 2016 were retrospectively reviewed. Results A total of 47 patients (18 male, 29 female; mean age 50.5 years; range, 23 to 74 years) consisting of 40 typical and 7 atypical carcinoid tumor cases were included in our study. Anatomical resection and systematic mediastinal lymph node dissection was performed on all patients. Pathological studies revealed lymphatic involvement in six patients (12.8%; 4 pN1 and 2 pN2). In the typical group (n=40), three patients were classified N1 (7.5%) and one patient N2 (2.5%). In the atypical group (n=7), one patient were classified N1 (14.3%) and one patient N2 (14.3%). Throughout the study, four patients with typical histology (10%) and two patients with atypical histology (28.6%) had nodal involvement. All six patients with nodal involvement underwent adjuvant radiotherapy. Atypical histology (p=0.005) and nodal involvement (p=0.008) were determined as negative prognostic factors in statistical analysis. Conclusion Systematic hilar and mediastinal nodal dissection play a crucial role in the surgical treatment of pulmonary carcinoid tumors.
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Song P, Zang R, Liu L, Dan X, Gao S. Long-term outcomes and prognostic factors of patients with surgically treated pulmonary atypical carcinoid tumors: our institutional experience with 68 patients. J Thorac Dis 2018; 10:4204-4211. [PMID: 30174865 DOI: 10.21037/jtd.2018.06.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Pulmonary atypical carcinoid (AC) tumors are rare malignant neoplasms and controversy exists regarding management and prognosis. The purpose of this retrospective study was to describe characteristics, and outcomes of patients treated for pulmonary AC tumors. Methods All patients with a diagnosis of primary pulmonary AC tumor treated from 1999 to 2013 were reviewed. Data collected included demographics, tobacco use, clinical presentation, tumor size and location, pathological stage, immunohistochemical expression, lymph node status, treatment, and survival. Results There were 55 men and 13 women with a mean age of 55 years. Symptoms were present in 47 patients (69.1%). Twenty-eight patients (41.2%) had a centrally located tumor and 40 patients (58.8%) presented with peripheral tumor localization. Operations included 49 lobectomies, 10 pneumonectomies, 6 bilobectomies, 2 sleeve lobectomies, and 1 wedge resection. There were no peri-operative mortalities. There were 22 patients in stage I, 27 in stage II, 19 in stage III. Twenty-nine (42.6%) patients died and twenty (29.4%) patients relapsed during the follow-up period. The 5- and 10-year survival rates for the 68 cases were 70.6% and 61.8%, respectively. Relapse-free survival was significantly worsened by increasing Ki-67 index (P<0.01) and lymph-nodes involvement (P=0.02). Multivariate Cox regression indicated that nodal status was significantly associated with survival (P=0.038). Conclusions Lymph-nodes involvement is the major adverse prognostic factor in AC. Recurrence is more common among patients with high Ki-67 level. The use of adjuvant chemotherapy postoperatively in patients with pathologically lymphnode-positive and pathologically lymphnode-negative disease seems to have no survival advantage.
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Affiliation(s)
- Peng Song
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ruochuan Zang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lei Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiayimaier Dan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Peri M, Botteri E, Pisa E, De Marinis F, Ungaro A, Spada F, Grana CM, Gasparri R, Spaggiari L, Romentz N, Badalamenti G, Russo A, Fazio N. A single-institution retrospective analysis of metachronous and synchronous metastatic bronchial neuroendocrine tumors. J Thorac Dis 2018; 10:3928-3939. [PMID: 30174834 DOI: 10.21037/jtd.2018.06.78] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Broncho-pulmonary neuroendocrine tumors (bpNETs) are rare malignancies and there is no consensus on therapeutical management of metastatic disease and follow-up after radical resection. Methods Clinical records of patients with a cytological or histological diagnosis of bpNETs and distant metastases (metachronous or synchronous), evaluated at the European Institute of Oncology between 1997 and 2014, were retrospectively analyzed. Data on patient demographics, pathology, imaging exams, surgical and non-surgical treatments were collected. P value descriptive data, uni- and multi-variate survival analysis were generated for all variables. Results With a median follow-up of 53 [9-215] months, 61 patients with metachronous and 47 with synchronous metastases were analysed. The most common tool of first recurrence detection was computed tomography. Liver (67%), lymph node (25%), bone (22%) and lung (16%) were the most common sites of relapse. Median time to recurrence was 5 years. Median overall survival (OS) was 72 months for the whole population, with no significant difference between patients with synchronous and metachronous metastases. Age, bone metastases, liver metastases and Ki-67 as a continuous variable all significantly correlated with prognosis at the multivariate analysis. Conclusions This is one of the largest, single-centre, series of metastatic bpNETs. Among patients with metachronous metastases the pattern of recurrences was heterogeneous as were the follow-up exams used to detect them. The results of our analysis may represent solid bases for designing prospective clinical trials in homogeneous settings of bpNETs.
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Affiliation(s)
- Marta Peri
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy.,Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, Palermo University Hospital, Palermo, Italy
| | - Edoardo Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Eleonora Pisa
- Division of Pathology, European Institute of Oncology, Milan, Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Antonio Ungaro
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Nicole Romentz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, Palermo University Hospital, Palermo, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, Palermo University Hospital, Palermo, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
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Migliore M, Nardini M. Parenchymal sparing resection for carcinoid of the right main bronchus. J Vis Surg 2018; 4:6. [PMID: 29445592 DOI: 10.21037/jovs.2017.12.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/14/2017] [Indexed: 11/06/2022]
Abstract
Surgery represents the treatment of choice for bronchial carcinoid tumors. Bronchoplasty for malignant and benign conditions are safe procedure but not often used. We present a case of carcinoid tumour of the right main bronchus successfully treated with parenchymal sparing resection and bronchoplasty. This is the preferable procedure for central typical carcinoid tumour located closed to the carina.
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Affiliation(s)
- Marcello Migliore
- Department of Thoracic Surgery, University Hospital Policlinico of Catania, Catania, Italy
| | - Marco Nardini
- Department of Thoracic Surgery, University Hospital Policlinico of Catania, Catania, Italy
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Pulmonary carcinoids - analysis of early and long-term surgical treatment outcomes in a group of 90 patients. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 14:225-229. [PMID: 29354173 PMCID: PMC5767771 DOI: 10.5114/kitp.2017.72225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/07/2017] [Indexed: 12/04/2022]
Abstract
Introduction Over the years, pulmonary carcinoids have been treated as locally malignant tumors because of the favorable prognosis. It is currently known that the clinical course of the disease is mainly dependent on the carcinoid subtype. Aim To analyze the early and long-term surgical treatment outcomes for typical and atypical carcinoids. Material and methods A total of 90 patients were treated surgically for pulmonary carcinoid tumors in the years 2007–2015. Typical carcinoids were diagnosed in 69 (77%) cases, while atypical carcinoids – in 21 (23%); 67 patients underwent lobectomy, 3 – sleeve lobectomy, 9 – bilobectomy, 2 – pneumonectomy, 1 – segmentectomy, and 8 – wedge resection. Results None of the patients died in the postoperative period. Complications occurred in 14.4% of patients. The most common complications included: arrhythmias (5.6%), prolonged air leak (3.3%), and residual pneumothorax (3.3%). Among the 21 patients with atypical carcinoids, N1 metastasis was found in 1 (4.8%) patient, while N2 – in 5 (23.8%) patients. In the group of 69 patients with typical carcinoids, N1 metastasis was revealed in 7 (10.1%) patients and N2 metastases – in 2 (2.9%) patients. The probability of 5-year survival in patients with typical and atypical carcinoids was 96% and 83%, respectively. During the follow-up period 7 (7.8%) patients, including 6 with atypical carcinoids, experienced local recurrence; distant metastasis occurred in 8 (8.9%) cases, including 6 with atypical carcinoids. Conclusions Although radical surgical treatment provides excellent long-term outcomes, it should be noted that patients with pulmonary carcinoids (especially with the atypical subtype) may experience local recurrence and distant metastases even many years after surgery.
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Herde RF, Kokeny KE, Reddy CB, Akerley WL, Hu N, Boltax JP, Hitchcock YJ. Primary Pulmonary Carcinoid Tumor: A Long-term Single Institution Experience. Am J Clin Oncol 2018; 41:24-29. [PMID: 26270444 PMCID: PMC4751073 DOI: 10.1097/coc.0000000000000221] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Primary carcinoid tumors of the lung are rare tumors which comprise approximately 0.5% to 5% of all lung malignancies in adults and roughly 20% to 30% of all carcinoid tumors. The purpose of this retrospective, descriptive study was to describe the incidence, characteristics, and outcomes of patients treated for primary pulmonary carcinoid tumor at a single institution. MATERIALS AND METHODS All patients with a diagnosis of primary pulmonary carcinoid tumor treated from 1989 to 2009 were reviewed. Data collected included demographics, pathology, tobacco use, clinical presentation, tumor location, tumor spread, treatment, and survival. RESULTS There were 59 cases of pulmonary carcinoid tumors: 47 typical (80%) and 12 atypical (20%). All but 4 patients underwent surgery, including 54 (92%) lung-sparing resections and 1 pneumonectomy. Five of 55 patients received concurrent adjuvant chemoradiation therapy; 4 patients with atypical and 1 with typical histology. Three additional patients with atypical carcinoid were treated only with adjuvant radiotherapy, palliative radiotherapy, or palliative chemotherapy, respectively. The Kaplan-Meier 5- and 10-year overall survivals were both 80% within the entire population. In the 88% of patients who achieved complete remission, disease-free survival was 98%. A review of a large series from the literature is also presented. CONCLUSIONS Surgical resection was primary and adequate therapy for most typical carcinoid tumors with high overall survival and disease-free survival. Adjuvant chemotherapy or radiotherapy might be considered for patients with atypical carcinoid tumors who present with adverse pathologic findings.
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Affiliation(s)
| | | | | | | | - Nan Hu
- Department of Internal Medicine, Division of Epidemiology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Daskalakis K, Kaltsas G, Öberg K, Tsolakis AV. Lung Carcinoids: Long-Term Surgical Results and the Lack of Prognostic Value of Somatostatin Receptors and Other Novel Immunohistochemical Markers. Neuroendocrinology 2018; 107:355-365. [PMID: 30244255 DOI: 10.1159/000493944] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Lung carcinoids (LCs) are often diagnosed at an early stage and surgical intervention becomes the next phase of treatment. To date, there is lack of long-term follow-up data after surgery and prognostication based on WHO classification criteria and evolving prognostic markers, particularly the expression of somatostatin receptors (SSR). METHODS We included 102 consecutive patients (72 women; age at baseline 51 ± 16 years [mean ± SD]) with LCs, who underwent thoracic surgery (n = 99) and/or laser treatment (n = 8). Hospital charts were reviewed for clinico-pathological parameters. Immunohistochemical (IHC) expression of SSR1-5 and other novel markers were studied with regard to their prognostic value. RESULTS Five- and 10-year overall survival (OS) was 96 and 83% respectively; relative survival (RS) was 101 and 93% respectively; and event-free survival (EFS) was 80 and 67% respectively. Independent prognostic factors for OS, RS and/or EFS were age at diagnosis, histopathological type and the presence of ipsilateral mediastinal subcarinal lymph node metastases. Macro-radicality of resective surgery and its extent were associated with increased OS and EFS. The IHC expression of SSR1-5 and other novel markers was not associated with OS or EFS. CONCLUSION The long-term outcome of surgically treated patients with LCs is favourable. Age, histopathological type and ipsilateral mediastinal subcarinal lymph node status at baseline were independent prognostic factors for survival and disease recurrence or progression. The extent of surgery and operative macro-radicality also had an impact on prognosis. None of the IHC markers tested appeared to be associated with disease prognosis.
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Affiliation(s)
| | - Gregory Kaltsas
- First Department of Propaupedic Internal Medicine, Endocrine Oncology Unit, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kjell Öberg
- Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden
| | - Apostolos V Tsolakis
- Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
- Cancer Centre Karolinska, CCK, Karolinska University Hospital, Stockholm, Sweden
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Kidd M, Modlin IM, Drozdov I, Aslanian H, Bodei L, Matar S, Chung KM. A liquid biopsy for bronchopulmonary/lung carcinoid diagnosis. Oncotarget 2017; 9:7182-7196. [PMID: 29467960 PMCID: PMC5805546 DOI: 10.18632/oncotarget.23820] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/15/2017] [Indexed: 01/31/2023] Open
Abstract
No effective blood biomarker exists to detect and clinically manage bronchopulmonary (BP) neuroendocrine tumors (NET). We developed a blood-based 51 NET-specific transcript set for diagnosis and monitoring and evaluated clinical performance metrics. It accurately diagnosed the tumor and differentiated stable from progressive disease as determined by RECIST criteria. Gene expression was evaluated in: a) publicly available BPNET transcriptomes (GSE35679); b) two BPNET cell-lines; and c) BPNET tissue with paired blood (n = 7). Blood gene expression was assessed in 194 samples including controls, benign lung diseases, malignant lung diseases and small bowel NETs. A separate validation study in 25 age- and gender-matched BPNETs/controls was performed. Gene expression measured by real-time PCR was scored (0–100%; normal: < 14%). Regression analyses, Principal Component Analysis (PCA), hierarchical clustering, Fisher's and non-parametric evaluations were undertaken. All 51 genes were identified in BPNET transcriptomes, tumor samples and cell-lines. Significant correlations were evident between paired tumor and blood (R2:0.63–0.91, p < 0.001). PCA and hierarchical clustering identified blood gene expression was significantly different between lung cancers and benign diseases, including BPNETs. Gene expression was highly correlated (R2: 0.91, p = 1.7 × 10-15) between small bowel and BPNET. For validation, all 25 BPNETs were positive compared to 20% controls (p < 0.0001). Scores were significantly elevated (p < 0.0001) in BPNETs (57 ± 28%) compared to controls (4 ± 5%). BPNETs with progressive disease (85 ± 11%) exhibited higher scores than stable disease (32 ± 7%, p < 0.0001). Blood measurements accurately diagnosed bronchopulmonary carcinoids, distinguishing stable from progressive disease. This marker panel will have clinical utility as a diagnostic liquid biopsy able to define disease activity and progression in real-time.
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Affiliation(s)
- Mark Kidd
- Wren Laboratories, Brandford, CT, USA
| | | | | | | | - Lisa Bodei
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Pikin O, Ryabov A, Sokolov V, Glushko V, Kolbanov K, Telegina L, Amiraliev A, Barmin V. Two-Stage Surgery Without Parenchyma Resection for Endobronchial Carcinoid Tumor. Ann Thorac Surg 2017; 104:1846-1851. [DOI: 10.1016/j.athoracsur.2017.06.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 05/21/2017] [Accepted: 06/21/2017] [Indexed: 12/20/2022]
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Cusumano G, Fournel L, Strano S, Damotte D, Charpentier MC, Galia A, Terminella A, Nicolosi M, Regnard JF, Alifano M. Surgical Resection for Pulmonary Carcinoid: Long-Term Results of Multicentric Study-The Importance of Pathological N Status, More Than We Thought. Lung 2017; 195:789-798. [PMID: 29022070 DOI: 10.1007/s00408-017-0056-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Histological subdivision into typical (TC) and atypical (AC) is crucial for treatment and prognosis of lung carcinoids but can be also very challenging, even for experts. In this study, we aimed to strengthen or reduce the prognostic value of several pathological, clinical, or per-operative factors some of which are still controversial. METHODS We retrospectively reviewed clinical records related to 195 patients affected by TC (159) or AC (36) surgically treated between 2000 and 2014, in three different centers. Survival and subtypes comparison analyses were performed to identify potential prognostic factors. RESULTS TCs showed a lower rate of nodal involvement than ACs (N0 = 94.9%; N1 = 1.9%; N2 = 3.2% in typical and N0 = 63.8%; N1 = 16.6%; N2 = 19.4% in atypical carcinoids, respectively, p < 0.0001). Long-term oncological results of resected carcinoids were significantly better in TCs than ACs with higher 5- and 10-year overall survival rates (97.2 and 88.2% vs. 77.9 and 68.2%, respectively; p = 0.001) and disease-free survival rates (98.2 and 90.3% in typical and 80.8 and 70.7% atypical carcinoids, respectively; p = 0.001). Risk factors analysis revealed that AC subtype [HR 4.33 (95% CI 1.72-8.03), p = 0.002], pathological nodal involvement [HR 3.05 (95% CI 1.77-5.26), p < 0.0001], and higher SUVmax [HR 4.33 (95% CI 1.03-7.18), p = 0.002] were independently and pejoratively associated with overall survival. Factors associated with a higher risk of recurrence were AC subtype [HR 6.13 (95% CI 1.13-18.86), p = 0.002]; nodal involvement [HR 5.48 (95% CI 2.85-10.51), p < 0.0001]; higher Ki67 expression level [HR 1.09 (95% CI 1.01-1.20), p = 0.047]; and SUVmax [HR 1.83 (95% CI 1.04-3.23), p = 0.035]. CONCLUSION Surgery for lung carcinoids allows satisfactory oncological results which mainly depend on carcinoid subtype dichotomy, pathological nodal status, and SUVmax.
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Affiliation(s)
- Giacomo Cusumano
- General Thoracic Surgery, "Vittorio Emanuele-Policlinico" Hospital , Catania, Italy.
| | - Ludovic Fournel
- Department of Thoracic Surgery, Cochin Hospital, AP-HP, Paris, France.,University Paris Descartes, Paris, France
| | | | - Diane Damotte
- Department of Pathology, Cochin Hospital, AP-HP, Paris, France
| | - Marie Christine Charpentier
- Department of Thoracic Surgery, Cochin Hospital, AP-HP, Paris, France.,Department of Pathology, Cochin Hospital, AP-HP, Paris, France
| | - Antonio Galia
- Department of Pathology, "Cannizzaro" Hospital, Catania, Italy
| | - Alberto Terminella
- General Thoracic Surgery, "Vittorio Emanuele-Policlinico" Hospital , Catania, Italy
| | | | - Jean Francois Regnard
- Department of Thoracic Surgery, Cochin Hospital, AP-HP, Paris, France.,University Paris Descartes, Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Cochin Hospital, AP-HP, Paris, France.,University Paris Descartes, Paris, France
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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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46
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Pericleous M, Karpathakis A, Toumpanakis C, Lumgair H, Reiner J, Marelli L, Thirlwell C, Caplin ME. Well-differentiated bronchial neuroendocrine tumors: Clinical management and outcomes in 105 patients. CLINICAL RESPIRATORY JOURNAL 2017; 12:904-914. [PMID: 28026127 DOI: 10.1111/crj.12603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/23/2016] [Accepted: 12/20/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Bronchial neuroendocrine tumors (NETs) are rare tumors representing approximately 20%-30% of all neuroendocrine tumors and 2%-3% of all adult lung cancers. Here, they present a large case series of well-differentiated bronchial NETs with the aim of investigating the behavior of these tumors and long-term outcomes. METHODS A retrospective review was performed of 105 patients with bronchial NETs managed in a tertiary referral center in the period between January 1998 and January 2012. RESULTS Bronchial NETs are commoner in females and the commonest presenting symptoms were cough (13.9%) and dyspnoea (11.6%). OctreoscanTM and Gallium-68 DOTATATE PET were found to have similar diagnostic sensitivity and FDG PET was more sensitive for higher-grade tumors. Over a median follow-up period of 35.5 months mortality rate was 5.7%. The 5-year survival was 76% and the 10-year survival was 62%. Female patients survived longer but this difference was not statistically significant (P = .59). Older age greater than 50 years (P = .027), higher levels of Chromogranin A (CgA) (P = .034), first-line treatment with surgery (P = .005), ki67 over 10% (P = .037), and tumor stage (P = .036) but not tumor grade (P = .22), were significantly associated with survival. DISCUSSION Several factors have been identified which are independently associated with survival including CgA levels greater than 100 pmol/L, tumor stage, age greater than 50, ki67 over 10% and having surgery as first-line treatment. There was no difference in survival between typical and atypical carcinoids.
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Affiliation(s)
- Marinos Pericleous
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Anna Karpathakis
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom.,University College London Cancer Institute, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Heather Lumgair
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Jonathan Reiner
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Laura Marelli
- Centre of Gastroenterology, Royal Free Hospital, London, United Kingdom
| | - Christina Thirlwell
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom.,University College London Cancer Institute, London, United Kingdom
| | - Martyn E Caplin
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
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Abstract
Tumors of trachea and bronchi are uncommon and can occur in the form of benign or low- and high-grade malignant tumors. Although tracheobronchial tumors (TBTs) represent only 0.6% of all pulmonary tumors, they are clinically significant. Delays in diagnosis of these tumors commonly occur because the signs and symptoms caused by these tumors are nonspecific and chest radiographs are often considered unremarkable. Therefore, novel radiological techniques and better access to flexible bronchoscopy enable detection of larger number of TBT. The purpose of this article is to provide a review of tracheal and bronchial tumors and discuss significant aspects of the different TBT with focus on clinical manifestations and diagnostic procedures.
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Affiliation(s)
- Ruza Stevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia;; Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia;; Clinic for Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
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48
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Affiliation(s)
- Lucian R Chirieac
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
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49
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Abstract
Bronchial and thymic carcinoids are rare. We present epidemiologic data and potential risk factors. The approach to bronchial and thymic carcinoid patients is discussed, from the initial diagnosis and evaluations to treatment. These malignancies follow staging systems of their site of origin. Because bronchial and thymic carcinoids are rare, we use many treatment strategies that have been demonstrated in gastrointestinal and pancreatic neuroendocrine tumors. The lack of information regarding efficacy in bronchial and thymic carcinoids, as well as the scarcity of therapeutic options available, demands the importance of clinical trials that include these patients.
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50
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Yang Z, Wang Z, Duan Y, Xu S. Clinicopathological characteristics and prognosis of resected cases of carcinoid tumors of the lung. Thorac Cancer 2016; 7:633-638. [PMID: 27755793 PMCID: PMC5093170 DOI: 10.1111/1759-7714.12377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/12/2016] [Accepted: 06/23/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Lung carcinoid tumors are rare, low-grade, malignant neoplasms with some unclear features. The aim of this study was to analyze clinicopathological features and long-term survival in patients with primary lung carcinoid tumors. METHODS Patients who underwent surgery in our clinic and were diagnosed with carcinoid tumors, between August 1997 and July 2012, were included in the study. Patient characteristics and clinicopathological factors were retrospectively evaluated. RESULTS Bronchial carcinoids comprised only 1.0% of lung cancer cases treated by resection. They are classified into two distinct categories: typical carcinoid (TC) and atypical carcinoid (AC) tumors. AC tumors occurred more frequently in younger patients and in smokers, and had a poorer prognosis than TC tumors. Overall three and five-year survival rates for TC and AC were 92.6% and 81.1%, respectively. Univariate analysis showed that tumor size ( P = 0.012) and histological type ( P = 0.013) are prognostic factors. Multivariate analysis revealed that only tumor size ( P = 0.044) was an independent prognostic factor. CONCLUSIONS The prognosis for bronchial carcinoid tumors was better than other types of lung cancer and TC was significantly better than AC. Radical lymph node dissection was the best treatment, with complete removal of the tumor. Tumor size was an independent prognostic factor for bronchial carcinoid tumors.
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Affiliation(s)
- Zhi Yang
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Zitong Wang
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yong Duan
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shaofa Xu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China.
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