Abstract
Background: We hypothesized: 1) resected pulmonary typical carcinoid (TC) will show a favorable clinical pattern compared to other bronchopulmonary neuroendocrine tumors (BPNETs); and 2) Atypical carcinoid (AC) and large-cell neuroendocrine carcinoma (LCNEC) patients will have similar outcomes. Methods: The Surveillance Epidemiology and End Result database was queried to compare demographics and tumor specific variables in patients undergoing resection for TC, AC, LCNEC and small cell lung cancer (SCLC) from 2001 to 2006. Results: Similar to LCNEC, AC patients had greater incidence of histologic positive lymph nodes compared to TC (P < 0.001). Survival analysis showed a mean survival of 40.0 ± 1.9 months for SCLC, 46.2 ± 2.2 months for LCNEC, 58.3 ± 2.3 months for AC, and 70.2 ± 0.2 months for TC tumors. TC patients demonstrated favorable survival, and SCLC patients poorer survival, compared to AC and LNEC patients (P < 0.01). Conclusion: AC tumors are a BPNET histology that exhibits clinical behavior distinct from TC. AC tumors should be staged, and treated with stage appropriate therapeutic strategies similar to other non-small cell lung cancers.
Highlights
In the 1999 World Health Organization classification atypical carcinoid (AC) and typical carcinoid (TC) tumors are considered “carcinoid type”
We hypothesized: 1) Resected pulmonary typical carcinoid (TC) will show a favorable clinical pattern compared to other bronchopulmonary neuroendocrine tumors (BPNETs); and 2) Atypical carcinoid (AC) and large-cell neuroendocrine carcinoma (LCNEC) patients will have similar outcomes
Carcinoid type is a sub-category of the bronchopulmonary neuroendocrine tumor (BPNET) classification that includes large-cell neuroendocrine carcinoma (LCNEC), and small cell lung cancer (SCLC) [1]
Summary
In the 1999 World Health Organization classification atypical carcinoid (AC) and typical carcinoid (TC) tumors are considered “carcinoid type”. Carcinoid type is a sub-category of the bronchopulmonary neuroendocrine tumor (BPNET) classification that includes large-cell neuroendocrine carcinoma (LCNEC), and small cell lung cancer (SCLC) [1]. AC tumors have neuroendocrine features of being organoid, trabecular, palisading, and rosette-like, with 2 to 10 mitotic figures seen in a 10 high powered focus [2]. AC tumors are distinguished from TC on histological criteria such as >2 mitotic figures per high power field, both show common histological features of spindle, oncocytic and melanocytic cells. In this study, using a large population cancer database, we tested the hypotheses 1) AC caries a worse prognosis than TC; 2) TC, AC, LNEC and SCLC represent a stepwise increasing negative prognosis within the BPNET classification; and 3) patient outcomes for AC tumors are similar to those for LNEC tumors
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