A National Study of Surgically Managed Atypical Pulmonary Carcinoid Tumors

Atypical pulmonary carcinoid tumors represent a subset of non-small cell lung cancer; however, their relative infrequency has left prognosis, management and long-term survival associated with atypical carcinoids, incompletely characterized.

Patients aged 18 years or more diagnosed with atypical or typical pulmonary carcinoid between 2010 and 2015 within the National Cancer Database were evaluated. Survival was measured using Kaplan-Meier survival and multivariable Cox proportional hazards regression, adjusting for patient and tumor attributes.

A total of 816 atypical and 5688 typical carcinoid patients were identified in the cohort. Patients with atypical carcinoids tended to be older, have larger tumors, and later stage disease. The unadjusted overall 5-year survival for atypical carcinoid patients was 84%, 74%, 52%, and 51% for stages I, II, III, and IV, respectively. The unadjusted 5-year survival for typical carcinoids was 93%, 93%, 89%, and 87% for stages I, II, III, and IV, respectively. Nodal upstaging (ie, lymph node metastases identified in surgical specimens of clinically staged N0 patients) was seen in 16% of atypical and 7% of typical carcinoid patients. Increasing age, comorbidities, and stage were identified as significant predictors of mortality for atypical patients in multivariable analysis. Extent of surgical resection (lobectomy vs sublobar) was not identified as a predictor of survival for atypical carcinoid.

Atypical carcinoid tumors represent a distinct subset of carcinoid tumors, with a tendency toward more aggressive behavior. Further study of the optimal surgical management is warranted.