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Devayani Madhav Niyogi
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EP1.12 - Small Cell Lung Cancer/NET (ID 202)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.12-05 - Is There a Role for Mediastinal Lymph Node Dissection in Pulmonary Carcinoids? (Now Available) (ID 2608)
08:00 - 18:00 | Presenting Author(s): Devayani Madhav Niyogi
- Abstract
Background
Pulmonary carcinoids are slow growing tumours with surgery being the mainstay of treatment. Histology(typical/atypical) and nodal status are known prognostic markers. In light of the results of the ACOSOG Z0030 trial, the role of mediastinal lymphnode dissection in surgery for NSCLC is being questioned. This question becomes more pertinent in pulmonary carcinoids, where nodal positivity is known to adversely impact survival and surgery is the only curative treatment option.
Method
We performed a retrospective analysis of a prospectively maintained database of surgery in pulmonary carcinoids. Data regarding histology, type of surgery, imaging, nodal status, margin status and follow up were captured from the database and where missing, from the electronic medical records. Statistical analysis was performed using SPSS version 20 for Mac.
Result
141 patients with pulmonary carcinoid tumours treated with curative intent in a single center from August 2004 to February 2017 were included. 108 (76.6%) were typical carcinoids and 29 (20.6%) were atypical carcinoids. 4 patients were not classified. 120 (86.42%) patients underwent mediastinal nodal sampling or systematic clearance. The median survival in patients undergoing lymphnode dissection was 66 months, where as it was 53.5 months in those who did not( p = 0.43). Twenty (16.66%) patients were node positive. Node positivity rate in typical carcinoids was 11.11%, while that in atypical carcinoids was 27.58% After a median follow up of 57 months, 115 (81.6%) patients are alive and disease free, 10 (7.1%) are alive with disease, 6 (4.3%) have died due to disease, 6 (4.3%) have died due to other causes. Estimated 5 yr survival in patients with typical carcinoids is 96.9% while that of patients with atypical histology is 67.8%. (p<0.001) Patients with positive nodes had an estimated 5 yr survival of 80.5% while that in node negative patients was 95.37%. (p=0.12).
Conclusion
In our series, the node positivity rate was higher than reported in literature and this could be seen in both patients with typical and atypical histology. Nodal positivity also showed a trend towards decreased survival showing that it is an important prognostic factor. Lymphnode dissection showed a trend towards improved survival, though not statistically significant. The lack of statistical significance could be attributed to the fewer number of cases in the study and the lower number of events. In view of the relatively low morbidity of the procedure and the lack of any other curative treatment option we suggest that systematic lymph node dissection be performed for all cases of pulmonary carcinoids. A randomized study to answer this question appears unlikely.
