Outcomes and patterns of failure in bronchial carcinoid tumors

To clarify the natural history, prognosis, and treatment failure patterns for bronchial carcinoid tumors according to their clinical and histopathologic features.

The charts of 241 patients from our institution with bronchial carcinoid tumors were reviewed. Thirty-four patients had no follow-up, yielding a study population of 206. Of the 206 patients, 62 had atypical carcinoid (AC) and 144 had typical carcinoid (TC) tumors.

The 5-, 10-, and 20-year disease-specific survival rates were lower in patients with AC (60.1%, 36.8%, and 28.1%, respectively) than in those with TC (79.0%, 62.9%, and 38.8%, respectively; p = 0.0002). Predictors of poor outcome included more advanced stage (p <0.00001), male gender (p = 0.019), symptoms at presentation (p = 0.013), and age >or=60 years (p = 0.02). Stage I AC was associated with a median disease-free survival of 96 months compared with 222 months for Stage I TC (p = 0.0002) and had an actuarial 22% locoregional failure rate 5 years after surgery compared with 6% for Stage I TC (p = 0.022). The disease-free survival for Stage II and III AC was worse than that for Stage II or III TC, but the difference did not reach statistical significance (p = 0.15). Locoregional failure was also prominent in Stage II and III AC. Second malignancies were common in patients with bronchial carcinoids (56 of 206 patients).

Stage-for-stage, the outcome is worse for patients with AC than for those with TC. Locoregional failure is common after curative resection, even for early-stage AC. Second cancers are common in patients with carcinoid tumors.