Neuroendocrine tumors of the lung.

PURPOSE OF REVIEW: The aim of this article is to answering different questions related to the treatment and prognosis of neuroendocrine lung tumors. RECENT FINDINGS: In neuroendocrine lung tumors, regardless of the grade of tumoral malignancy, the general growth during the past years of the nodal involvement percentage detected in lung neuroendocrine tumors might be explained by accepting surgical treatment as the norm and a complete mediastinal nodal dissection. Among non-small-cell carcinomas, large cell neuroendocrine carcinoma is the tumor with the worst prognosis. Nodal invasion clearly decreases the possibility of long-term survival in these patients, confirming the importance of preoperative and perioperative staging. A definitive survival advantage for postoperative adjuvant therapy has yet to be reported; tumoral genetics studies may contribute to specifying its indication. The importance of neuroendocrine differentiation in non-small-cell lung carcinomas for the treatment and prognosis of these tumors is a reason to intensify research. SUMMARY: In the surgical treatment of lung neuroendocrine carcinomas, nodal mediastinal dissection should always be performed. In the large neuroendocrine carcinoma, experience confirms the possibility of surgical treatment in early stages; in all cases, adjuvant treatment should always be established. The presence of synaptophysin in squamous carcinoma tumors and adenocarcinoma tumors in stage I seems to be associated with a worse prognosis.

Typical and atypical carcinoid tumours: analysis of the experience of the Spanish Multi-centric Study of Neuroendocrine Tumours of the Lung.

BACKGROUND: This study examines the experience of the Spanish Multi-centric Study of Neuroendocrine Tumours of the Lung with patients treated surgically for typical and atypical carcinoid tumours. METHODS: From 1980 to 2002, 661 patients were treated surgically for 569 typical carcinoid tumours and 92 atypical carcinoid tumours. Three hundred and four cases were studied retrospectively from 1980 to 1997 (261 typical carcinoid and 43 atypical carcinoid tumours); the other 357 new cases (308 typical carcinoid and 49 atypical carcinoid tumours) were collected prospectively from 1998 to 2002. Tumours were classified according the 1999 classification from the WHO and the International Association for the Study of Lung Cancer (IASLC). Several variables were reviewed in all patients. Univariate and multivariate statistical analyses were performed in order to determine whether clinical characteristics were associated with significant differences in survival. RESULTS: In the total of the patients, 5-year survival for different tumours was as follows: typical carcinoid: overall survival 97%; with nodal involvement 100%; atypical carcinoid: overall 78%; with nodal involvement 60%. A significant difference in survival was found between patients in the retrospective and prospective groups with atypical carcinoid and nodal involvement. The comparative analysis of several factors in typical and atypical carcinoid tumours showed a significant difference for mean age, tumour size, nodal involvement and distant metastases. CONCLUSION: Nodal involvement and histological sub-type appear as the most important factors influencing the prognosis. Adequate lung resection and systematic radical mediastinal lymphadenectomy should always be performed. Sleeve resection could be performed in central typical and atypical carcinoid tumours, avoiding pneumonectomy.

[Trends in prognostic factors for neuroendocrine lung tumors]. / Tendencias en los factores pronósticos de los tumores pulmonares neuroendocrinos.

OBJECTIVE: The aim of this study was to analyze trends in a variety of prognostic factors for neuroendocrine lung carcinomas through analysis of 2 groups of surgically treated patients. PATIENTS AND METHODS: Group A contained the first 361 patients, treated between 1980 and 1997. That group was analyzed retrospectively and contained 261 patients with typical carcinoid tumors, 43 with atypical carcinoid tumors, 22 with large-cell neuroendocrine carcinoma, and 35 with small-cell neuroendocrine carcinoma. Group B contained 404 patients enrolled prospectively between 1998 and 2002: 308 with typical carcinoid tumors, 49 with atypical carcinoid tumors, 18 with large-cell neuroendocrine carcinoma, and 29 with small-cell neuroendocrine carcinoma. The following clinical variables were considered: sex, mean age, tumor site, tumor size, lymph node involvement, stage, metastasis, and local recurrence. The 1997 TNM classification was used for staging of lung cancer and survival analysis was performed along with assessment of factors influencing survival. Statistical analysis of the data involved univariate and multivariate analysis. RESULTS: In both groups, significant differences were observed between patients with typical and atypical carcinoid tumors in terms of mean age, tumor size, node involvement, and recurrence. In group A, female sex, node involvement, and recurrence differed between patients with atypical carcinoid tumors and those with large-cell neuroendocrine carcinoma; the same was true for group B, with the exception of lymph node involvement. Node involvement differed between patients with small-cell versus large-cell neuroendocrine carcinoma in group A but not group B. Both groups displayed significant differences in overall survival and survival of patients with lymph node involvement between patients with typical and atypical carcinoid tumors and between patients with atypical carcinoid tumors and those with large-cell neuroendocrine carcinoma; no differences were observed between patients with large-cell versus small-cell neuroendocrine carcinoma. Histological type and lymph node involvement had the greatest influence on prognosis in the multivariate analysis. CONCLUSIONS: A well-defined trend is observed in prognostic factors for neuroendocrine lung tumors. Histological type and lymph node involvement show the greatest influence on survival.

Tendencias en los factores pronósticos de los tumores pulmonares neuroendocrinos / Trends in prognostic factors for neuroendocrine lung tumors

Objetivo: Este estudio tiene como objetivo determinar la tendencia de distintos factores pronósticos en carcinomas neuroendocrinos del pulmón a través del análisis de 2 grupos de pacientes tratados quirúrgicamente. Pacientes y métodos: En el grupo A se incluyeron los primeros 361 casos, tratados entre 1980 y 1997 --261 carcinoides típicos (CT), 43 carcinoides atípicos (CA), 22 carcinomas neuroendocrinos de células grandes (CNECG) y 35 carcinomas neuroendocrinos de células pequeñas (CNECP)--, que se estudiaron retrospectivamente. El grupo B estuvo compuesto por 404 casos, recogidos desde 1998 a 2002 --308 CT, 49 CA, 18 CNECG y 29 CNECP--, que se estudiaron prospectivamente. Las variables clínicas consideradas fueron: sexo, edad media, localización tumoral, tamaño tumoral, afectación ganglionar, estadio, metástasis y recurrencia local. Se utilizó la clasificación TNM del carcinoma broncogénico de 1997 y se practicó un estudio de supervivencia y de factores que influyen en ella. Se realizó un análisis estadístico uni y multivariante con los datos obtenidos. Resultados: Por lo que se refiere al CT y al CA, se observaron diferencias significativas en los 2 grupos de pacientes en cuanto a la edad media, el tamaño tumoral, la afectación ganglionar y la recurrencia. Entre CA y CNECG, el sexo, la afectación ganglionar y la recurrencia difirieron en el grupo A; lo mismo ocurrió en el grupo B, con la excepción de la afectación ganglionar. Entre CNECG y CNECP, la diferencia en la afectación ganglionar observada en el grupo A no estuvo presente en los pacientes del grupo B. Respecto a la supervivencia, global y por afectación ganglionar, se observaron diferencias significativas en ambos grupos al comparar CT frente a CA y CA frente a CNECG; no se encontraron diferencias entre CNECG y CNECP. El tipo histológico y la afectación ganglionar mostraron la mayor influencia pronóstica en análisis multivariante. Conclusiones: En los carcinomas neuroendocrinos de pulmón se observa una tendencia definida en sus factores pronósticos. El tipo histológico y la detección de afectación ganglionar se muestran como los factores con mayor influencia en la supervivencia

Objective: The aim of this study was to analyze trends in a variety of prognostic factors for neuroendocrine lung carcinomas through analysis of 2 groups of surgically treated patients. Patients and methods: Group A contained the first 361 patients, treated between 1980 and 1997. That group was analyzed retrospectively and contained 261 patients with typical carcinoid tumors, 43 with atypical carcinoid tumors, 22 with large-cell neuroendocrine carcinoma, and 35 with small-cell neuroendocrine carcinoma. Group B contained 404 patients enrolled prospectively between 1998 and 2002: 308 with typical carcinoid tumors, 49 with atypical carcinoid tumors, 18 with large-cell neuroendocrine carcinoma, and 29 with small-cell neuroendocrine carcinoma. The following clinical variables were considered: sex, mean age, tumor site, tumor size, lymph node involvement, stage, metastasis, and local recurrence. The 1997 TNM classification was used for staging of lung cancer and survival analysis was performed along with assessment of factors influencing survival. Statistical analysis of the data involved univariate and multivariate analysis. Results: In both groups, significant differences were observed between patients with typical and atypical carcinoid tumors in terms of mean age, tumor size, node involvement, and recurrence. In group A, female sex, node involvement, and recurrence differed between patients with atypical carcinoid tumors and those with large-cell neuroendocrine carcinoma; the same was true for group B, with the exception of lymph node involvement. Node involvement differed between patients with small-cell versus large-cell neuroendocrine carcinoma in group A but not group B. Both groups displayed significant differences in overall survival and survival of patients with lymph node involvement between patients with typical and atypical carcinoid tumors and between patients with atypical carcinoid tumors and those with large-cell neuroendocrine carcinoma; no differences were observed between patients with large-cell versus small-cell neuroendocrine carcinoma. Histological type and lymph node involvement had the greatest influence on prognosis in the multivariate analysis. Conclusions: A well-defined trend is observed in prognostic factors for neuroendocrine lung tumors. Histological type and lymph node involvement show the greatest influence on survival