Elsevier

The Annals of Thoracic Surgery

Volume 76, Issue 6, December 2003, Pages 1838-1842
The Annals of Thoracic Surgery

Original article: general thoracic
Assessment of outcomes in typical and atypical carcinoids according to latest WHO classification

https://doi.org/10.1016/S0003-4975(03)01194-9Get rights and content

Abstract

Background

Pulmonary carcinoid tumors represent a group of malignant neoplasms comprised of neuroendocrine cells. In 1999, the World Health Organization (W.H.O.) proposed the definitive classification of neuroendocrine tumors based on the criteria from Travis and associates. The W.H.O. described two different groups of carcinoid tumors: typical carcinoids (TC) and atypical carcinoids (AC). Few reports have reviewed their data according to the current classification, and therefore, prognosis and standard therapy for TC and AC are still uncertain.

Methods

From 1980 to 2001, 98 pulmonary resections have been performed for primary bronchial carcinoid tumors in our Thoracic Department of the University of Milan. We reviewed original histology using the current W.H.O. criteria and identified 88 patients with TC and 10 with AC. We reviewed the outcomes in each group.

Results

The 5 year-overall survival rate was 91.9% for TC and 71% for AC. The 10-year overall survival rate was 89.7% for TC and 60% for AC. The 5-year TNM-related survival rates in the TC group were: IA-B, 100%; IIA-B, 75%; and IIIA, 50%. At 10 years, they were: IA-B, 100%; IIA-B, 75%; and IIIA, 0%. The 5-year survival rates in the AC group were: IA-B, 100%; IIA-B, 100%; and IIIA, 0%. At 10 years, they were: IA-B, 100%; IIA-B, 66%; and IIIA, 0%.

Conclusions

Prognosis is favorable for both subtypes in the early stage. Advanced stages are related to better prognosis in TC. Recurrences rate is worse in the AC subtype. Our data suggest avoiding limited resections when feasible in AC. Parenchyma-sparing resections should be encouraged in TC.

Section snippets

Patients and methods

From 1980 to 2001, 98 patients underwent parenchyma lung resection for carcinoid tumors in our Thoracic Department of the University of Milan. There were 52 men and 46 women. The original histologic diagnosis has been reclassified according to the 1999 W.H.O. classification by a spectrum of pathologists from different departments. Therefore, using actual criteria, there were 88 cases of typical carcinoid and 10 cases of atypical carcinoid.

We used contrast-enhanced computed tomography (CT) for

Results

We did not have any intraoperative deaths. The 90-day mortality rate was 2% of patients: one myocardial infarction and one stroke. We never had severe postoperative surgical complications; we noted four cardiac arrhythmias and five pneumonias pharmacologically recovered.

At the time of last follow-up in 2001, information for typical carcinoid group was noted as follows: 6 (6.8%) of the 88 patients died from recurrence of disease. Five were N1 (31.2% of all N1 in typical carcinoid subtype) and 1

Comment

Carcinoids represent a spectrum of neuroendocrine malignant tumors with different behaviors and prognoses depending on their differentiation. The 1999 W.H.O. by Travis and associates recognized two different forms of carcinoid: typical carcinoid and atypical carcinoid.

Because, unfortunately, most reports regarding prognosis and management of these tumors have been published before the 1999 W.H.O. one, currently, the appropriate standard surgical management of typical and atypical carcinoids is

References (18)

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