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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: 11] [Impact Index Per Article: 3.7] [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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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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Boland JM, Kroneman TN, Jenkins SM, Terra SBSP, Xie H, Molina J, Mounajjed T, Roden AC. Ki-67 Labeling Index in Pulmonary Carcinoid Tumors: Comparison Between Small Biopsy and Resection Using Tumor Tracing and Hot Spot Methods. Arch Pathol Lab Med 2020; 144:982-990. [PMID: 31944862 DOI: 10.5858/arpa.2019-0374-oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Pulmonary carcinoids are classified as typical or atypical by assessing necrosis and mitoses, which usually cannot be adequately assessed on small biopsies. Ki-67 is not currently used to grade pulmonary carcinoids, but it may be helpful to determine preliminary grade in biopsies. However, the rate at which Ki-67 could underestimate or overestimate grade on small biopsies has not been well studied. OBJECTIVE.— To compare Ki-67 labeling obtained on small biopsies to subsequent resection. DESIGN.— Ki-67 was performed on paired biopsy and resection specimens from 55 patients. Slides were scanned using Aperio ScanScope. Labeling index was determined using automated hot spot and tumor tracing methods. RESULTS.— The study included 41 typical and 14 atypical carcinoids. Atypical carcinoids were larger and had more distant metastases. Death from disease occurred in 3 patients (all had atypical carcinoids). Median hot spot Ki-67 labeling index was greater in resection compared with biopsy by 0.7% (P = .02). Median tumor tracing Ki-67 was lower in resection compared with biopsy by 0.5% (P < .001). Receiver-operating characteristic analysis showed similar hot spot Ki-67 cutoffs to predict atypical histology (3.5% for biopsy, 3.6% for resection; area under the curve [AUC], 0.75 and 0.74, respectively). Different optimal cutoffs were needed for tracing method based on biopsy (2.1%; AUC, 0.75) compared with resection (1.0%; AUC, 0.67). CONCLUSIONS.— Hot spot Ki-67 tends to underestimate grade on small biopsies, whereas grade is overestimated by tumor tracing. Hot spot Ki-67 cutoff of 3.5% predicted atypical histology for both biopsy and resection. Different biopsy and resection cutoffs were necessary for tumor tracing, which would make clinical implementation more difficult.
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Affiliation(s)
- Jennifer M Boland
- From the Departments of Laboratory Medicine and Pathology (Drs Boland, Terra, Mounajjed, and Roden, and Ms Kroneman), Health Sciences Research (Ms Jenkins), and Oncology (Drs Xie and Molina), Mayo Clinic, Rochester, Minnesota
| | - Trynda N Kroneman
- From the Departments of Laboratory Medicine and Pathology (Drs Boland, Terra, Mounajjed, and Roden, and Ms Kroneman), Health Sciences Research (Ms Jenkins), and Oncology (Drs Xie and Molina), Mayo Clinic, Rochester, Minnesota
| | - Sarah M Jenkins
- From the Departments of Laboratory Medicine and Pathology (Drs Boland, Terra, Mounajjed, and Roden, and Ms Kroneman), Health Sciences Research (Ms Jenkins), and Oncology (Drs Xie and Molina), Mayo Clinic, Rochester, Minnesota
| | - Simone B S P Terra
- From the Departments of Laboratory Medicine and Pathology (Drs Boland, Terra, Mounajjed, and Roden, and Ms Kroneman), Health Sciences Research (Ms Jenkins), and Oncology (Drs Xie and Molina), Mayo Clinic, Rochester, Minnesota
| | - Hao Xie
- From the Departments of Laboratory Medicine and Pathology (Drs Boland, Terra, Mounajjed, and Roden, and Ms Kroneman), Health Sciences Research (Ms Jenkins), and Oncology (Drs Xie and Molina), Mayo Clinic, Rochester, Minnesota
| | - Julian Molina
- From the Departments of Laboratory Medicine and Pathology (Drs Boland, Terra, Mounajjed, and Roden, and Ms Kroneman), Health Sciences Research (Ms Jenkins), and Oncology (Drs Xie and Molina), Mayo Clinic, Rochester, Minnesota
| | - Taofic Mounajjed
- From the Departments of Laboratory Medicine and Pathology (Drs Boland, Terra, Mounajjed, and Roden, and Ms Kroneman), Health Sciences Research (Ms Jenkins), and Oncology (Drs Xie and Molina), Mayo Clinic, Rochester, Minnesota
| | - Anja C Roden
- From the Departments of Laboratory Medicine and Pathology (Drs Boland, Terra, Mounajjed, and Roden, and Ms Kroneman), Health Sciences Research (Ms Jenkins), and Oncology (Drs Xie and Molina), Mayo Clinic, Rochester, Minnesota
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Gagliardi I, Tarquini M, Ambrosio MR, Giannetta E, Borges de Souza P, Gafà R, Carnevale A, Franceschetti P, Zatelli MC. NEP-Score Thresholds Predict Survival of Patients With Bronchial Carcinoids. Front Endocrinol (Lausanne) 2020; 11:621557. [PMID: 33628200 PMCID: PMC7897663 DOI: 10.3389/fendo.2020.621557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023] Open
Abstract
Survival prognostic markers are extremely needed to better define therapeutic strategies in patients with bronchial carcinoids (BC). We aim to verify the applicability of the NEP-Score in a homogeneous BC cohort and identify a derivative prognostic marker, the NEP-Score at diagnosis (NEP-D) that does not consider new metastases during follow-up. Sixty-four patients (38 females, and 26 males, mean age at diagnosis 58.9 ± 1.7 years) with BC were retrospectively evaluated. NEP-Score was calculated at the end of follow-up (NEP-T). A derivative score, the NEP-Score at diagnosis (NEP-D) that does not consider new metastases during follow-up, was then assessed. Patients were subdivided according to their living status at the end of follow-up. A NEP-Score threshold was investigated to predict survival. Mean NEP-T and mean NEP-D were significantly lower in live patients at end of follow-up. A NEP-T cut-off >138 significantly predicts survival. Atypical BC relapsed more frequently than Typical BC. Male gender and previous malignancy were negative prognostic factors for survival. We confirmed NEP-Score applicability in BC and NEP-D utility, being the latter a simple, quick, and cheap prognostic score that can help clinicians in decision making. The identified NEP-D threshold can predict NEN aggressiveness and may be used to define the best personalized therapeutic strategy. In this context, a validation study is needed.
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Affiliation(s)
- Irene Gagliardi
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Mario Tarquini
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Endocrine Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Elisa Giannetta
- Section of Medical Physiopathology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Patricia Borges de Souza
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberta Gafà
- Pathology Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Aldo Carnevale
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Paola Franceschetti
- Endocrine Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Endocrine Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
- *Correspondence: Maria Chiara Zatelli,
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Gross JL, Vega MAT, Frenhi GS, Torres SM, Campos AHJFM, Pinto CAL, Costa FD, Haddad FJ. Bronchial carcinoid tumors: second primary neoplasms and outcomes of surgical treatment. ACTA ACUST UNITED AC 2019; 45:e20180140. [PMID: 31531614 PMCID: PMC7247769 DOI: 10.1590/1806-3713/e20180140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 01/09/2019] [Indexed: 03/23/2023]
Abstract
Objective: To analyze determinants of prognosis in patients with bronchial carcinoid tumors treated surgically and the potential concomitance of such tumors with second primary neoplasms. Methods: This was a retrospective analysis of 51 bronchial carcinoid tumors treated surgically between 2007 and 2016. Disease-free survival (DFS) was calculated by the Kaplan-Meier method, and determinants of prognosis were evaluated. Primary neoplasms that were concomitant with the bronchial carcinoid tumors were identified by reviewing patient charts. Results: The median age was 51.2 years, 58.8% of the patients were female, and 52.9% were asymptomatic. The most common histology was typical carcinoid (in 80.4%). Five-year DFS was 89.8%. Ki-67 expression was determined in 27 patients, and five-year DFS was better among the patients in whom Ki-67 expression was ≤ 5% than among those in whom it was > 5% (100% vs. 47.6%; p = 0.01). Concomitant primary neoplasms were observed in 14 (27.4%) of the 51 cases. Among the concomitant primary neoplasms that were malignant, the most common was lung adenocarcinoma, which was observed in 3 cases. Concomitant primary neoplasms were more common in patients who were asymptomatic and in those with small tumors. Conclusions: Surgical resection is the mainstay treatment of bronchopulmonary carcinoid tumors and confers a good prognosis. Bronchial carcinoid tumors are likely to be accompanied by second primary neoplasms.
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Vesterinen T, Salmenkivi K, Mustonen H, Kuopio T, Lappi-Blanco E, Paavonen T, Vainio P, Knuuttila A, Carpén O, Haglund C, Arola J. Performance of Finnish biobanks in nationwide pulmonary carcinoid tumour research. Virchows Arch 2019; 476:273-283. [PMID: 31385069 PMCID: PMC7028842 DOI: 10.1007/s00428-019-02625-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022]
Abstract
Finnish hospital-integrated biobanks administer millions of formalin-fixed paraffin-embedded tissue samples collected within the clinical diagnostics. According to the Finnish Biobank Act, these samples can be coupled with patients' clinical follow-up data and the data retrieved from national health registries. We collected a nationwide pulmonary carcinoid tumour series from Finnish biobanks to study prognostic factors as well as to explore how the number of tumours found in the Finnish biobanks corresponds to the number of tumours registered by the Finnish Cancer Registry (FCR). Finnish biobanks identified 88% of the tumours registered by the FCR and were able to deliver 63%. The main reasons for lacking samples were paucity of resected primary tumour tissue, incompatible primary diagnosis, and the absence of tissue blocks in the archives. The main bottleneck in the sample application process was retrieving patient data. Altogether, we received 224 tumour samples with appropriate patient data and identified six prognostic factors for shorter disease-specific survival: age over 56 years at the time of diagnosis, tumour size over 2.5 cm, atypical histology, Ki-67 proliferation index higher than 2.5%, hilar/mediastinal lymph node involvement at the time of diagnosis, and the presence of metastatic disease. In conclusion, the Finnish biobank infrastructure offers excellent opportunities for tissue-based research. However, to be able to develop the biobank operations further, involving more medical knowledge in the sample and data acquisition process is a necessity. Also, when working with tissue samples collected over decades, histological expertise is essential for re-evaluation and re-classification of the samples.
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Affiliation(s)
- Tiina Vesterinen
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, Helsinki, Finland.
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Tukholmankatu 8, Helsinki, Finland.
| | - Kaisa Salmenkivi
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, Helsinki, Finland
| | - Harri Mustonen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland
| | - Teijo Kuopio
- Department of Biological and Environmental Science, University of Jyväskylä, Survontie 9, Jyväskylä, Finland
- Department of Pathology, Central Finland Health Care District, Keskussairaalantie 19, Jyväskylä, Finland
| | - Elisa Lappi-Blanco
- Department of Pathology, Center for Cancer Research and Translational Medicine, Oulu University Hospital and University of Oulu, Aapistie 5, Oulu, Finland
| | - Timo Paavonen
- Department of Pathology, Fimlab Laboratories and Department of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, Finland
| | - Paula Vainio
- Department of Pathology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland
| | - Aija Knuuttila
- Department of Pulmonary Medicine, Heart and Lung Center, and Cancer Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland
| | - Olli Carpén
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, Helsinki, Finland
- Research Program in Systems Oncology, University of Helsinki, Haartmaninkatu 8, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, Helsinki, Finland
| | - Johanna Arola
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, Helsinki, Finland
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Vesterinen T, Mononen S, Salmenkivi K, Mustonen H, Räsänen J, Salo JA, Ilonen I, Knuuttila A, Haglund C, Arola J. Clinicopathological indicators of survival among patients with pulmonary carcinoid tumor. Acta Oncol 2018; 57:1109-1116. [PMID: 29463166 DOI: 10.1080/0284186x.2018.1441543] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pulmonary carcinoids (PC) are rare malignant neoplasms that cover approximately 1% of all lung cancers. PCs are classified by histological criteria as either typical (TC) or atypical (AC). Histological subtype is the most studied prognostic factor. The aim of this study was to evaluate if other tissue or clinical features are associated with patient outcomes. MATERIAL AND METHODS We retrospectively reviewed clinical records of 133 PC patients who underwent operation in the Helsinki University Hospital between 1990 and 2013. Tissue specimens were re-evaluated, processed into tissue microarray format and stained immunohistochemically with serotonin, calcitonin, adrenocorticotropic hormone (ACTH), thyroid transcription factor-1 (TTF-1) and Ki-67. Survival and risk analyses were performed. RESULTS Based on histology, 75% (n = 100) of the tumors were TCs and 25% (n = 33) ACs. TCs had higher 10-year disease-specific survival (DSS) rate than ACs (99% (95% CI, 93-100%) for TCs vs. 82% (95% CI, 61-92%) for ACs). Hormonally active tumors expressing serotonin, calcitonin or ACTH were noted in 53% of the specimens but hormonal expression was not associated with DSS. TTF-1 was positive in 78% of the specimens but was not associated with DSS. Ki-67 index varied between <1% and 15%. Ki-67 ≥ 2.5% was associated with shorter DSS (p = .004). The presence of metastatic disease (p = .001), tumor size ≥30 mm (p = .021) and atypical histology (p = .011) were also associated with disease-specific mortality. CONCLUSIONS We conclude that PCs are uncommon tumors. When resected, the long-term survival is in general favorable. In this consecutive, single-institution cohort of patients, presence of metastatic disease, tumor size, histological subtype and Ki-67 index were associated with shorter disease-specific survival. As TC and AC have different clinical behaviors, the correct tumor classification at the time of diagnosis is a necessity.
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Affiliation(s)
- Tiina Vesterinen
- HUSLAB, Helsinki Biobank, Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Sanna Mononen
- Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Kaisa Salmenkivi
- HUSLAB, Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Mustonen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Räsänen
- Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Jarmo A. Salo
- Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Ilonen
- Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Aija Knuuttila
- Department of Pulmonary Medicine, Heart and Lung Center, and Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Johanna Arola
- HUSLAB, Helsinki Biobank, Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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