Disease relapse in relation to lymph node sampling in lung carcinoid patients

Area of Science:

• Oncology
• Thoracic Surgery
• Pathology

Background:

• The prognostic value of lymph node (LN) sampling extent in pulmonary carcinoid (PC) patients is unclear.
• Current post-surgery follow-up guidelines for PC lack robust evidence due to short follow-up periods in retrospective studies.

Purpose of the Study:

• To investigate the relationship between lymph node dissection extent and disease relapse in pulmonary carcinoid patients.
• To establish long-term follow-up data for pulmonary carcinoid patients using a population-based cohort.

Main Methods:

• Utilized Dutch nationwide pathology and cancer registries for patients with surgically resected PC (2003-2012, updated to 2020).
• Assessed LN dissection extent (number, location, completeness per ESTS guidelines).
• Evaluated relapse-free interval (RFI) using Kaplan-Meier and multivariate regression analyses.

Main Results:

• Included 662 patients with a median follow-up of 87.5 months; 10% experienced relapse (primarily liver and locoregional).
• Median RFI was 48.1 months. Poor prognostic factors included atypical carcinoid, pN1/2, and R1/R2 resection.
• Only 7% of patients had complete LN dissection per ESTS guidelines; 44% had at least one N2 LN examined. Among cN0 patients, 5.9% had pN1 and 2.5% had pN2 disease.

Conclusions:

• Pulmonary carcinoid relapse occurred in 10% of patients, emphasizing the need for long-term follow-up.
• Extended mediastinal lymph node sampling was infrequently performed but systematic nodal evaluation offers prognostic value for distant relapse.