Bronchial carcinoids. Review of 124 cases

A total of 124 patients with bronchial carcinoid were seen at Memorial Sloan-Kettering Cancer Center between 1949 and 1983. Of these, 68 were female and 56 were male. The age range was 12 to 82 years (median 55 years). Eleven of the tumors were incidental pathological findings at autopsy or operation and were excluded from survival data determinations. At the time of diagnosis, 82 patients had disease confined to the lung or bronchus, 19 had regional lymph node metastases, and 12 had distant metastases. Patients with distant metastases were more commonly male and smokers, and their tumors were mainly atypical carcinoids histologically, compared with those of patients with localized disease. Patients with distant disease were treated with external radiation and/or chemotherapy, and their median survival was 8 months. Of the 101 patients with disease localized to one hemithorax, endobronchial resection was performed in six and pulmonary resection in 95 (pneumonectomy 14, bilobectomy nine, lobectomy 52, sleeve resection five, segmentectomy 15). Recurrence following endobronchial resection was observed in four of six patients. Disease-free actuarial survival (calculated by the Kaplan-Meier method) following pulmonary resection was 92% at 5 years and 77% at 10 years. Factors predisposing to recurrence were tumor size greater than 3 cm (p less than 0.004), an atypical carcinoid on histologic study (p less than 0.001), and regional lymph node metastases (p = 0.01). Disease-free survival at 5 and 10 years in 19 patients who had regional lymphatic metastases was 74% and 53%, compared with 96% and 84% in those without lymphatic metastases. We conclude that (1) carcinoid tumors are malignant and 10% of patients present with metastases and (2) for patients with clinically localized tumors, the prognosis is determined by the size and histologic features of the tumor and the status of the regional lymph nodes, which must be assessed at thoracotomy.