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Incidence and Prognostic Significance of Carcinoid Lymph Node Metastases
- Source :
- The Annals of thoracic surgery. 106(4)
- Publication Year :
- 2018
-
Abstract
- Background Pulmonary carcinoid tumors are often considered indolent tumors. The prognostic significance of lymph node (LN) metastases and the need for mediastinal dissection is controversial. We sought to determine the incidence, risk factors, and prognosis of LN metastases in resected carcinoid patients. Methods Patients undergoing lung resection for carcinoid and removal of ≥10 LNs were identified in the National Cancer Database from 2004 to 2014. Typical (TCs) and atypical carcinoids (ACs) were included. Clinical and pathologic LN status was assessed. Overall survival (OS) was analyzed using log-rank test and Cox hazard regression analysis. Results A total of 3,335 patients (TC 2,893; AC 442), underwent resection (lobectomy/bilobectomy 84%, pneumonectomy 8%, sublobar resection 8%). LN involvement was present in 21% of patients (N1 15%, N2 6%) and increased with tumor size and AC histology. Tumor size was an independent predictor of LN disease. The rate of nodal upstaging was 13% (TC 11%, AC 24%). Independent predictors of OS were AC type (HR 3.25 [95% CI 2.19-4.78]) and LN metastases (HR 2.3 [1.49-3.58]). LN disease was associated with worse survival for TC > 2 cm (5-year OS 87% versus 94%, p = 0.005) and AC (58% versus 88%, p = 0.001), but not for small (≤ 2 cm) TC patients (5-year OS 93% versus 92%, p = 0.67). Conclusions A substantial number of well-staged carcinoid patients had LN metastases. Large tumor size is a valuable predictor of carcinoid nodal disease. LN involvement was an independent predictor of worse survival. Nodal dissection in tumors > 2 cm and in atypical subtype can yield important prognostic information.
- Subjects :
- Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
Lung Neoplasms
medicine.medical_treatment
Carcinoid tumors
Carcinoid Tumor
030204 cardiovascular system & hematology
Gastroenterology
03 medical and health sciences
Pneumonectomy
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
Lymph node
Aged
Neoplasm Staging
Retrospective Studies
business.industry
Incidence (epidemiology)
Cancer
Histology
Retrospective cohort study
Middle Aged
medicine.disease
Prognosis
United States
Survival Rate
Dissection
medicine.anatomical_structure
030220 oncology & carcinogenesis
Lymphatic Metastasis
Surgery
Female
Lymph Nodes
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15526259
- Volume :
- 106
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- The Annals of thoracic surgery
- Accession number :
- edsair.doi.dedup.....770ac98e9b48d6977b2184c61e07760e