Clinicopathological Features And Prognosis Of Bronchopulmonary Carcinoid:25-year Single Center Retrospective Study

ObjectiveThe incidence of bronchopulmonary carcinoid(BPC)is low and the clinical manifestations lack specificity.To date,the clinical studies on BPC are limited,especially lack prospective studies.The diagnosis,treatment and prognostic factors of BPC are somewhat controversial.Our purpose was to summarize the clinicopathological features,diagnosis and treatment of BPC,to evaluate the clinical efficacy of surgery on lung carcinoid,and to analyze the main prognostic factors affecting the survival of BPC.Methods1.We retrospectively collected the clinical data of patients with BPC admitted to the Chinese PLA General Hospital between May 1993 and December 2017.The data collected included gender,age,smoking,accompanying diseases,symptoms,pathological classification,tumor stage,information on examination and treatment,etc.According to the pathological results,the carcinoid patients were divided into typical carcinoid(TC)and atypical carcinoid(AC),and group comparison was performed.The covariates were set according to the specific data.Depending on the data type and sample size,the quantitative variables were analyzed by ANOVA or rank sum test,and the qualitative variables were analyzed by chi-square test or Fisher's exact test.2.To obtain information on post-treatment,disease progression and survival,patients were followed up by telephone,questionnaire,or checked medical records.The Kaplan-Meier method was used to calculate the survival rate of patients and to map the survival curve.We divided the patients into two groups according to the factors like pathological classification,gender,age,smoking,concomitant diseases,symptoms,Ki-67 index,positive margin,surgical approach,tumor staging,chemotherapy.Then compare the effects of different factors on prognosis by univariate analysis,and use Log-rank test;multivariate analysis by Cox proportional hazard model.Statistical analysis was performed using software version R-3.4.0(2017-04-21).All tests in this study were two-sided tests with a test level of a=0.05.Results1.A total of 223 patients had a diagnosis of BPC were included in the study.Among them,AC,TC,complex malignant neoplasms with carcinoid as main components(CC),and tumourlet were 137,70,12,and 4,respectively.There were 151 male patients and 72 female patients.The age ranged from 13 to 82 years,with a median age of 55 years and an average age of 53.7±13.47 years.The onset age of TC was younger than that of AC and CC(P<0.0001),and the age of AC was younger than CC(P=0.0685).AC were more common with men(P<0.0001).Malignant features on CT such as burrs(36/95 vs 5/37,P=0.0065),lobulated(67/95 vs 12/37,P=0.0001),mediastinal lymphadenopathy(50/100 vs 9/43,P=0.0015)were more likely to manifest in patients with AC.The mean SUVmax of PET/CT in AC was higher than TC(11.27 vs 3.54,P=0.012).2.164 patients with BPC were treated with surgery.There were 57 patients with TC and 107 patients with AC.AC was more likely to have lymph node metastasis(P=0.0003).The l-year,5-year,and 10-year overall survival rates of BPC were 95.6%,79.1%,and 77.1%,respectively.The 1-year,5-year,and 10-year overall survival rates of TC were 100.0%,100.0%,and 97.7%,respectively.The 1-year,5-year,and 10-year overall survival rates of AC were 93.0%,65.0%,and 63.8%,respectively.Univanate analysis showed age(P<0.0001),smoking history(P=0.0005),pathological subtype(P<0.0001),Ki-67 index(P<0.0001),T stage(P<0.0001),tumor stage(P=0.0001)were the prognostic factor.Multivariate analysis showed that age P<0.014),pathological subtype(P=0.047),and tumor stage(P=0.011)were independent prognostic factors.ConclusionsBPC occurred more in middle-aged men,with a high proportion of AC.Compared with TC,patients with AC were older,more likely to had malignant signs on imaging examination,more likely to had lymph node metastasis.The accuracy of non-surgical routine pathological methods such as bronchoscopy biopsy,CT-guided puncture,intraoperative frozen pathology,for the diagnosis of BPC were low.Surgery is an important treatment for BPC,the overall prognosis of patients with BPC underwent surgery was good.Age,pathological subtype and tumor stage were independent risk factors for long-term survival after lung cancer surgery.