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Meghan Taylor
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P50 - Small Cell Lung Cancer/NET - Real World Outcomes (ID 232)
- Event: WCLC 2020
- Type: Posters
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P50.11 - Long-Term Survival after Surgical Resection of Carcinoid Tumors in a Population-Based Cohort (ID 3258)
00:00 - 00:00 | Presenting Author(s): Meghan Taylor
- Abstract
Introduction
Pulmonary carcinoid (PC) tumors constitute approximately 2% of all lung malignancies. Because of their rarity, management of these tumors remains controversial, although surgical management generally follows similar recommendations as non-small cell lung cancer. We sought to define characteristics of typical carcinoids (TCs) and atypical carcinoids (ACs) and identify factors that predict overall survival (OS) after curative-intent surgical resection.
Methods
We examined patients from a population-based cohort who underwent lung resection for PCs from 12 hospitals across 7 different healthcare systems from 2009 to 2019. Patients were staged according to the 8th edition of the tumor, node, and metastasis (TNM) staging system. TCs, ACs, and PCs with unspecified histology were compared using Chi-square/Fisher’s exact, or Kruskal-Wallis tests. 5-year OS was analyzed using Kaplan-Meier curves and survival between groups was compared with the log-rank test. Univariate and multivariable Proportional Hazards models were used to determine predictors of OS.
Results
We identified 148 patients. 76 were TCs, 31 ACs, and 41 had unspecified histology. Median age was 65 years (range 22-83) and the majority were female (71%). 20% were African American; 46% were nonsmokers. Pathologic stages were 0 (3%), I (74%), II (16%), and III (8%). Surgical procedures were 8% wedge resection, 76% lobectomy, 5% bilobectomy, 4% pneumonectomy, 5% segementectomy, and 2% lobectomy+wedge. Median follow-up time was 42 months. Patients with ACs were significantly older (p=0.0004) and more likely to be later pathologic stage (p=0.0175) than TCs/unspecifieds but did not differ in sex, race, smoking status, surgical technique, extent of resection, number of lymph nodes sampled, or 30-day postoperative mortality. The combined 5-year OS rate was 84% (95% CI: 74%-91%); 49% for atypical, 91% typical (p= 0.0003). Patients with pathologic N1/N2 nodal metastases had a significantly decreased OS compared to those without nodal disease (p=0.0048). Multivariable models showed that atypical histology (p=0.0055), male sex (p=0.0093), and pathologic N1/N2 nodal metastases (p=0.0281) remained significant negative predictors of OS after adjusting for age at surgery.
Demographic/Clinical Characteristics
Category
N (%)
Typical
76 (51)
Atypical
31 (21)
Not Specified
41 (28)
Total
N=148
p-value
Age
median (range)
63.5 (34-83)
69 (44-78)
61 (22-82)
65 (22-83)
0.0004
Sex
Male
20 (26)
12 (39)
11 (27)
43 (29)
0.4113
Female
56 (74)
19 (61)
30 (73)
105 (71)
Race
Caucasian
61 (80)
22 (71)
35 (85)
118 (80)
0.3179
Black or African-American
15 (20)
9 (29)
6 (15)
30 (20)
Smoking Status
Active
16 (21)
7 (23)
4 (10)
27 (18)
0.152
Former
19 (25)
14 (45)
12 (29)
45 (30)
Never
36 (47)
10 (32)
22 (54)
68 (46)
Not Reported
5 (7)
0 (0)
3 (7)
8 (5)
Number of patients with any lymph node sampled during surgery
4 (5)
3 (10)
1 (2)
8 (5)
0.4436
Total number of lymph nodes sampled
median (range)
3.5 (1-4)
7 (2-13)
1 (1)
3.5 (1-13)
0.2484
Aggregate pathologic Stage (8th)
Occult/Stage 0
2 (3)
2 (6)
0 (0)
4 (3)
0.0175
Stage I
61 (80)
15 (48)
33 (80)
109 (74)
Stage II
9 (12)
8 (26)
6 (15)
23 (16)
Stage III
4 (5)
6 (19)
2 (5)
12 (8)
Pathologic T stage (8th)
pTX/pT0
1 (1)
1 (3)
0 (0)
2 (1)
0.0182
pT1
60 (79)
17 (55)
29 (71)
106 (72)
pT2
14 (18)
10 (32)
8 (20)
32 (22)
pT3
0 (0)
3 (10)
4 (10)
7 (5)
pT4
1 (1)
0 (0)
0 (0)
1 (1)
Pathologic N stage (8th)
pNX
3 (4)
3 (10)
1 (2)
7 (5)
0.1459
pN0
61 (80)
18 (58)
35 (85)
114 (77)
pN1
9 (12)
6 (19)
4 (10)
19 (13)
pN2
3 (4)
4 (13)
1 (2)
8 (5)
Pathologic M stage (8th)
pM0
76 (100)
31 (100)
41 (100)
.
30-day postoperative mortality
No
73 (96)
29 (94)
41 (100)
143 (97)
0.3375
Yes
3 (4)
2 (7)
0 (0)
5 (3)
Conclusion
Our results are consistent with previous reports showing that TCs and ACs have different disease characteristics, with ACs having a worse prognosis following resection. However, it is unknown to what extent other prognostic factors are involved. We found that presence of nodal metastasis (N1/N2) and sex were additional predictors of OS for patients with carcinoid tumors. Future studies should assess the involvement of pathologic stage and lymph node involvement which could lead to an improvement in prognostication and patient management.
