1. Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size.
- Author
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Cattoni M, Vallières E, Brown LM, Sarkeshik AA, Margaritora S, Siciliani A, Filosso PL, Guerrera F, Imperatori A, Rotolo N, Farjah F, Wandell G, Costas K, Mann C, Hubka M, Kaplan S, Farivar AS, Aye RW, and Louie BE
- Subjects
- Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Outcome Assessment, Health Care, Pneumonectomy methods, Prognosis, Proportional Hazards Models, Retrospective Studies, Tumor Burden, Lung diagnostic imaging, Lung pathology, Lung surgery, Lung Neoplasms mortality, Lung Neoplasms pathology, Lung Neoplasms surgery, Neoplasm Staging methods, Neuroendocrine Tumors mortality, Neuroendocrine Tumors pathology, Neuroendocrine Tumors surgery
- Abstract
Objective: Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors., Methods: We retrospectively analyzed 510 consecutive patients (female/male, 313/197; median age, 61 years; interquartile range, 51-70) undergoing lung resection for a primary neuroendocrine tumor between 2000 and 2015 in 8 centers. Multivariable analysis was performed using a Cox proportional hazard model to identify factors associated with disease-specific survival. A new staging system was proposed on the basis of the results of this analysis. Kaplan-Meier disease-specific survival was analyzed by stage using the proposed and the 7th TNM staging system., Results: Follow-up was completed in 490 of 510 patients at a median of 51 months (interquartile range, 18-99). Histology (G1-typical carcinoid vs G2-atypical carcinoid vs G3-large-cell neuroendocrine carcinoma) and pT were independently associated with survival, but pN was not. After regrouping histology and pT, we proposed the following staging system: IA (pT1-2G1), IB (pT3G1, pT1G2), IIA (pT4G1, pT2-3G2, pT1G3), IIB (pT4G2, pT2-3G3), and III (pT4G3). The 5-year survivals were 97.9%, 81.0%, 69.1%, 51.8%, and 0%, respectively. By using the 7th TNM, 5-year survivals were 95.0%, 92.3%, 67.7%, 70.9%, and 65.1% for stage IA, IB, IIA, IIB, and III, respectively., Conclusions: Incorporating histology and regrouping tumor stage create a unique neuroendocrine tumor staging system that seems to predict survival better than the 7th TNM classification., (Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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