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Partial lobectomy may be preferable in patients with localized node-negative and atypical carcinoid tumors

Liz Meszaros, MDLinx | October 24, 2017

Five-year survival in patients with localized node-negative bronchial carcinoid tumors (CTs) and atypical carcinoid tumors (ACTs) is excellent, and a lobectomy (L) with mediastinal node dissection may provide no additional benefits compared to partial lobectomy (PL), and only serve to increase the length of hospitalization, according to study results presented October 19-21, 2017 at the North American Neuroendocrine Tumor Society (NANETS) 2017 Symposium in Philadelphia, PA.

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Localized node-negative and atypical carcinoid tumors

Lobectomy with mediastinal node dissection may be of no benefit, and only increase length of hospitalization.

“Bronchial carcinoid tumors usually have an indolent clinical behavior, and surgical resection is the main treatment modality for patients with early stage disease. However, it is unclear if L with mediastinal node dissection is superior compared to PL,” noted lead author Gustavo Westin, MD, and colleagues from the Mayo Clinic, Rochester, MN.

For this study, these researchers used data from 1,551 patients diagnosed with T1N0 or T2N0 typical carcinoid tumors (CT) and 167 patients with atypical carcinoid tumors (ACT) found in the National Cancer Database from 2004-2012. All diagnoses were pathologically confirmed, as were negative surgical margins. Patients underwent L or PL (segmental or wedge resection) as initial treatment and did not receive chemotherapy or radiation.

Researchers used Kaplan-Meier analysis to analyze overall survival (OS), log-rank tests for statistical comparisons, and Cox proportional hazards modelling to control for age, sex, race, grade, year of diagnosis, Charlson/Deyo Score, insurance, income, and facility type. Finally, they compared post-surgical hospital stays using t-tests.

In all, approximately 75 of CT patients and 78% of ATC patients underwent L. In both groups, 90-day mortality was less than 1%. Researchers found, however, that patients who underwent L had longer postoperative hospital stays (mean: 5.3 vs 4.3 days; P < 0.001).

Five-year survival rates in these patients were excellent. CT patients undergoing L had a 5-year survival of 95%, compared to 93% in those undergoing PL (P=0.62). In ACT patients undergoing L, 5-year survival was 89%, compared with 81% in those undergoing PL (P=0.28).

Upon multivariate analysis, researchers found that the only prognostic factor was increasing age, which was associated with reduced survival. When comparing PL to L, hazard ratio for death in CT patients was 1.09 (95% CI: 0.65, 1.78; P=0.71), compared with 1.25 (95% CI: 0.45, 3.23; P=0.65) for ACT patients.

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