Prognostic Thresholds of Mitotic Count and Ki-67 Labeling Index for Recurrence and Survival in Lung Atypical Carcinoids

Patrick Soldath ^1,2,3, Daniel Bianchi ⁴, Beatrice Manfredini ⁵

¹European Neuroendocrine Tumor Society Center of Excellence, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
²Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark.
³Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
⁴Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy.
⁵Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University of Pisa, 56126 Pisa, Italy.
⁶Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
⁷Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark.
⁸Department of Oncology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
⁹Department of Surgical Gastroenterology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.
¹⁰Department of Endocrinology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.

⁰European Neuroendocrine Tumor Society Center of Excellence, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.

Cancers +

|

February 10, 2024

View abstract on PubMed

Summary

Prognostic thresholds for atypical carcinoid (AC), a rare lung neuroendocrine tumor, were identified. Mitotic count and Ki-67 index levels predict recurrence and survival, aiding clinical decision-making.

Area Of Science

Pulmonology
Oncology
Pathology

Background

Atypical carcinoid (AC) is a rare lung neuroendocrine neoplasm with variable malignant potential.
Accurate prognostic markers are crucial for managing AC, a condition with unpredictable outcomes.

Purpose Of The Study

To establish prognostic thresholds for mitotic count and Ki-67 labeling index in radically resected AC.
To evaluate the predictive value of these thresholds for tumor recurrence and patient survival.

Main Methods

Retrospective review of 78 patients with radically resected AC.
Time-dependent receiver operating characteristic curves and Youden index used to determine prognostic thresholds.
Aalen-Johansen estimator and Fine-Gray subdistribution hazard models employed for survival analysis.

Main Results

Prognostic thresholds identified: mitotic count >3/2 mm² (recurrence) and >4/2 mm² (death); Ki-67 index >14% (recurrence) and >11% (death).
Both mitotic count and Ki-67 index thresholds independently predicted survival (p < 0.001 and p = 0.015, respectively).
Patients exceeding these thresholds showed significantly higher rates of recurrence and mortality.

Conclusions

Established mitotic count and Ki-67 index thresholds offer valuable prognostic information for AC.
These markers can assist clinicians in treatment planning and outcome prediction for AC patients.
Further research validating these thresholds in larger cohorts is warranted.

Keywords:

atypical carcinoid lung neuroendocrine neoplasms prognostic biomarkers supra-carcinoid