Lobar versus sub-lobar surgery for pulmonary typical carcinoid, a population-based analysis

Area of Science:

• Thoracic surgery
• Surgical oncology
• Pulmonary carcinoid tumors

Background:

• Optimal surgical management for resectable typical carcinoid (TC) lung tumors, specifically lobar resection (L-R) versus sub-lobar resection (SL-R), remains a subject of debate.
• This population-based study investigates surgical strategies for pulmonary TC.

Purpose of the Study:

• To compare the survival outcomes of lobar resection (L-R), sub-lobar resection (SL-R), and no surgery (NS) for patients with typical carcinoid (TC) lung tumors.
• To evaluate the role of adjuvant therapies in the management of pulmonary TC.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients aged 66 years and older diagnosed with pulmonary TC between 2000 and 2012.
• A linked SEER-Medicare cohort (2000-2007) was used to assess chemotherapy (CTX) use and comorbidity.
• Five-year survival rates were analyzed using univariate and multivariate Cox regression models.

Main Results:

• In the SEER cohort (n=1,506), 49% underwent L-R, 29% SL-R, and 21% no surgery (NS).
• Patients receiving NS were older, had higher tumor stage, greater comorbidity, and were more likely to receive radiotherapy (XRT) and CTX.
• Survival was nearly 100% for L-R and SL-R groups versus 72% for NS (P<0.001). No significant survival difference was found between L-R and SL-R (HR 1.1, P=0.663), but NS was associated with worse survival (HR 3.6, P<0.001). XRT in the NS cohort correlated with increased mortality risk (HR 2.3, P=0.017).

Conclusions:

• Sub-lobar resection (SL-R) demonstrates comparable survival to lobar resection (L-R) and is superior to no surgery (NS) for typical carcinoid (TC) lung tumors.
• SL-R should be considered when L-R is not feasible.
• The study found no survival benefit from adjuvant chemotherapy (CTX) or radiotherapy (XRT) in this cohort.