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M. Szolkowska



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    P1.02 - Biology/Pathology (ID 614)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P1.02-037 - Pulmonary Carcinoid Tumors: A Prognostic Implications of Ki-67 Proliferative Index (ID 9873)

      09:30 - 16:00  |  Author(s): M. Szolkowska

      • Abstract

      Background:
      Division of typical (TC) and atypical (AC) carcinoids is based on the mitotic index and/or the presence of necrosis. A mitotic rate is a well-established and highly prognostic factor, but many studies indicate that assessment of proliferative activity based on Ki-67 value could be easier and more reproducible. The aim of the study was: •assessment of Ki-67 index in PC and its usefulness in distinguishing TC from AC, •to determine whether the mean Ki-67 index is significantly different in TC and AC, •selection the optimal cut-off Ki-67 value that would help predict overall survival in pulmonary carcinoids (PC).

      Method:
      The clinicopathological features from 329 resected PC were correlated and survival analysis were performed. Mitoses and the proliferative index (PI) were analyzed. For mitotic counting, a scale bar depicting an area of 2 mm[2 ]was provided and for PI assessment, the percentage of positively stained cells by Ki-67 in the area with the highest proliferative activity was counted.

      Result:
      There were 217 (66%) TC and 112 (34%) AC, with a median follow-up time of 7,6 ys (230 females and 99 males). The mean age at diagnosis was 52,8 years, median 55 y. Most tumors were localized centrally (73,7%). AC were larger than TC (2,54 vs 1,9cm) and more common located peripherally. Lymph nodes involvement was present in 49 cases (15%), N1-34 (10%) and N2-15 (5%), frequently in AC.The high cellular atypia, cartilage destruction, invasion of peribronchial tissue or adjacent lung parenchyma, presence of pleural, perineural and vascular invasion correlated with AC. ACs were associated with significantly higher Ki-67 indices (8,7%, median 7%) than TCs (3,1%, median 2%). There were significant correlations between high PI and: large tumor size, mitotic activity, vascular invasion and lymph node metastases.The Ki-67 index was a good factor differentiating TC from AC, with cut-off ≤ 4% for TC and > 4% for AC, with high specifity (90%) and sensitivity (70%) and with high likelihood ratio (2,97).The number of deaths among the patients with TC and AC was 7 (6,3%) and 31 (14,3%) respectively. The 5-,10- and 15 year overall survivals for the entire group were 92,8%, 86,8% and 78,6% respectively.

      Conclusion:
      Ki-67 is an effective grading tool for PC and for differentiation between TC from AC. Apart the mitotic count and necrosis, the Ki-67 index should be incorporated into the mandatory histological criteria for diagnosis PC. The optimal cut-off value of Ki-67 that helps distinguish TC from AC is 4%.

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    P2.16 - Surgery (ID 717)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P2.16-017 - Surgical Treatment of Bronchial Carcinoid Tumors: Evaluation of Survival and Prognostic Factors. A Single-Center Experience (ID 9863)

      09:30 - 16:00  |  Author(s): M. Szolkowska

      • Abstract

      Background:
      Pulmonary carcinoids (PC) are rare malignant neuroendocrine tumors with indolent course. It is estimated that PC overall encompass 1% to 5% of all lung neoplasms. The surgical resection is the preferred treatment modality but the indolent nature of the disease makes interpretation of survival numbers problematic.

      Method:
      Aims: We report a single institution experience with PCs over a 17-year period to gain a better understanding of prognostic factors related to the management of these rare tumors. Material and Methods: Patients who underwent operations for primary pulmonary carcinoid tumor at National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland between 1998 and 2015 were identified from the database. Their medical records were reviewed for clinical presentation, tumor spread, pathology, treatment modalities, and survival.

      Result:
      There were 329 cases of PCs: 217 (66%) typical (TC) and 112 (34%) atypical (AC) carcinoids, with a median follow-up time of 7,6 years. There were 230 females (69,9%) and 99 males (30,1%). The most common symptoms were cough (38,7%), dyspnea (15,9%) and hemoptysis (14%). No patients showed a carcinoid syndrome. There was no correlation between smoking status and PCs. The majority of patients were in stage I disease (67,4%), only 6,4% in stage III and IV (6,4%). Involvement of lymph nodes was present in 49 cases (14,9%), N1 -34 (10,3%) and N2 – 15 (4,6%). Infiltration of bronchial or vessel margin (R1) was revealed in 10 cases (3%). Surgical treatment consisted of: 247 lobectomies (75,1%), 30 pneumonectomies (9,1%), 36 bilobectomies (10,9%), 5 anatomic segmentectomies (1,5%), 8 wedge resections (2,4%), 3 – bronchoplastic procedures without lung resection (0,9%). Radical mediastinal lymphadenectomy was added in all cases. The number of death among the patients with TC and AC was 7 (6,3%) and 31 (14,3%) respectively. Kaplan-Meier 1-, 5-, 10- and 15-year overall survivals for the entire group were 98,8%, 92,8%, 86,8% and 78,6% respectively.

      Conclusion:
      • PCs are tumors with an excellent prognosis, even in the presence of metastases in lymph nodes and positive surgical margin. • None of the symptoms and stage of tumors as well as the distance of the tumor from the surgical margin did not affect significantly the overall survival. • The age of patients, the type of operation and performance status (ECOG score) had vital importance for overall survival. • Surgical resection is the best and adequate therapy for PCs with high overall survival and disease-free survival but long-time observation is necessary.