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.
Highlights
Bronchial carcinoids (BC) are uncommon bronchial/pulmonary tumors characterized by a wide spectrum of clinical behavior, representing 20%–30% of all neuroendocrine neoplasms (NEN), whose incidence rates range from 0.2 to 2/100.000 people/year, and most series suggest a higher incidence in women as compared to men and in Caucasian as compared to black patients [1,2,3,4,5,6]
Our results show that the NEP-Score, corresponding to the NEPT score in our study, is a valuable prognostic tool in bronchial carcinoids (BC) management, since higher NEP-T scores associated with a worse survival
Our present study demonstrated the validity of the NEP-Score in an independent series of 64 BC patients (7 ABC and 57 TBC) with very long follow-up
Summary
Bronchial carcinoids (BC) are uncommon bronchial/pulmonary tumors characterized by a wide spectrum of clinical behavior, representing 20%–30% of all neuroendocrine neoplasms (NEN), whose incidence rates range from 0.2 to 2/100.000 people/year, and most series suggest a higher incidence in women as compared to men and in Caucasian as compared to black patients [1,2,3,4,5,6]. BC management is mainly influenced by tumor differentiation and Ki-67 [9,10,11,12,13,14], but markers of clinical outcomes that could predict patient survival are still lacking [15,16,17,18,19]. Despite improvements in prognostic grading and staging systems, the challenge to predict BC patient’s outcome is difficult This is true for patients with ABC, since they often have a worse prognosis with a greater tendency to metastasize and recur locally [20], with more frequent distant metastases (liver or bone) more frequent as compared to local recurrence [20]. We considered the impact of other prognostic factors, such as gender, differentiation, and previous malignancy
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