Diagnosis, Treatment And Prognostic Analyses Of Bronchopulmonary Carcinoid Tumors

Objective To explore the diagnosis, treatment and prognostic factors of bronchopulmonary carcinoid tumors (BPC).Methods The clinical data of126surgical patients with pathologically confirmed as BPC in Cancer Hospital of Chinese Academy of Medical Sciences, from May1999to October2012, were reviewed retrospectively. We summarized the clinical features of BPC, and discussed the diagnosis and treatment. The prognostic factors considered in the univariate and multivariate analyses of65patients who followed up more than5years included sex, age, smoking history, pathological type and tumor stage. All analyses were performed using SPSS17.0. Survival and univariate analysis were estimated according to the Kaplan-Meier method. The statistical difference between the survival curves was determined using the log-rank test. Multivariate analysis by Cox proportional hazard model was used to investigate the relative importance of different prognostic factors. A p-value lower than0.05was considered statistically significant.Results There were83males and43females. The median age at diagnosis was51years (range19～78years).58tumors were in a central location and68in a peripheral location.70typical and56atypical carcinoids were classified. Postoperative staging revealed65patients in stage Ⅰ,37in stage Ⅱ,23in stage Ⅲ and one in stage Ⅳ.39patients had lymph node involvement. Surgical procedures included one wedge resection, one segmentectomy,77lobectomies,10bilobectomies,15sleeve resections,15pneumonectomies,4bronchoplastic resections,2carinal resections and one exploratory thoracotomy. The1-,3-and5-year overall survival rates were86.2%,73.8%and64.6%, respectively. The median survival time was72months. Univariate analysis showed that sex (P=0.029), age (P=0.003), smoking history (P=0.039), pathological type (P<0.001), tumor stage (P<0.001), postoperative radiochemotherapy (P<0.001), lymph node metastasis (P<0.001) and surgical type (P=0.042) were prognostic factors. Multivariate analysis revealed that pathological type (P=0.019) and lymph node metastasis (P<0.001) were independent prognostic factors.Conclusions BPC is a rare malignant tumor arising from the lung, characterized by low potential malignancy, earlier age of onset, more central tumors and good prognosis. Surgery is the first choice for treatment of BPC. The main resection procedure is lobectomy. Routine systematic lymph node dissection is recommended. The role of radiotherapy and chemotherapy in the treatment of BPC is still unclear. Pathological type and lymph node metastasis are independent prognostic factors.