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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
      • Slides

      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.

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