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Reuling EMBP, Naves DD, Kortman PC, Broeckaert MAM, Plaisier PW, Dickhoff C, Daniels JMA, Radonic T. A Multimodal Biomarker Predicts Dissemination of Bronchial Carcinoid. Cancers (Basel) 2022; 14:cancers14133234. [PMID: 35805004 PMCID: PMC9265109 DOI: 10.3390/cancers14133234] [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: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Curatively treated bronchial carcinoid tumors have a relatively low metastatic potential. Gradation into typical (TC) and atypical carcinoid (AC) is limited in terms of prognostic value, resulting in yearly follow-up of all patients. We examined the additional prognostic value of novel immunohistochemical (IHC) markers to current gradation of carcinoids. Methods: A retrospective single-institution cohort study was performed on 171 patients with pathologically diagnosed bronchial carcinoid (median follow-up: 66 months). The risk of developing distant metastases based on histopathological characteristics (Ki-67, p16, Rb, OTP, CD44, and tumor diameter) was evaluated using multivariate regression analysis and the Kaplan−Meier method. Results: Of 171 patients, seven (4%) had disseminated disease at presentation, and 164 (96%) received curative-intent treatment with either endobronchial treatment (EBT) (n = 61, 36%) or surgery (n = 103, 60%). Among the 164 patients, 13 developed metastases at follow-up of 81 months (IQR 45−162). Univariate analysis showed that Ki-67, mitotic index, OTP, CD44, and tumor diameter were associated with development of distant metastases. Multivariate analysis showed that mitotic count, Ki-67, and OTP were independent risk factors for development of distant metastases. Using a 5% cutoff for Ki-67, Kaplan−Meier analysis showed that the risk of distant metastasis development was significantly associated with the number of risk predictors (AC, Ki-67 ≥ 5%, and loss of OTP or CD44) (p < 0.0001). Six out of seven patients (86%) with all three positive risk factors developed distant metastasis. Conclusions: Mitotic count, proliferation index, and OTP IHC were independent predictors of dissemination at follow-up. In addition to the widely used carcinoid classification, a comprehensive analysis of histopathological variables including Ki-67, OTP, and CD44 could assist in the determination of distant metastasis risks of bronchial carcinoids.
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Affiliation(s)
- Ellen M. B. P. Reuling
- Department of Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.M.B.P.R.); (C.D.)
- Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands;
| | - Dwayne D. Naves
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Pim C. Kortman
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Mark A. M. Broeckaert
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Peter W. Plaisier
- Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands;
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.M.B.P.R.); (C.D.)
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Johannes M. A. Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
- Cancer Center Amsterdam, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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