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Observation may not be suitable for small typical lung carcinoids. Nodal involvement, even in small tumors, independently predicts worse survival, suggesting resection is generally recommended.

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Area of Science:

  • Pulmonary Medicine
  • Surgical Oncology
  • Thoracic Surgery

Background:

  • Typical lung carcinoids are neuroendocrine tumors.
  • Observation is considered for small typical lung carcinoids.
  • The risk of tumor growth and lymphatic spread during observation is not well understood.

Purpose of the Study:

  • To evaluate the impact of tumor growth and lymphatic spread in typical lung carcinoids.
  • To identify predictors of lymph node positivity.
  • To determine the effect of tumor size and lymph node status on survival.

Main Methods:

  • Analysis of National Cancer Database cases of typical lung carcinoid resections (2006-2016).
  • Determination of predictors for lymph node involvement.
  • Assessment of survival based on tumor size and lymph node status.

Main Results:

  • 12.3% of resected typical lung carcinoids had positive lymph nodes.
  • 5.4% of subcentimeter tumors showed node positivity.
  • Increasing tumor size correlated with nodal involvement.
  • Nodal involvement significantly worsened 5-year survival (89.5% vs 94.0%).
  • Tumor size did not independently predict survival, but node positivity did.

Conclusions:

  • Nodal metastases occur in over 5% of subcentimeter typical lung carcinoids.
  • Lymph node involvement is an independent predictor of poorer survival.
  • Tumor size is not a predictor of survival.
  • Surgical resection is generally recommended for typical lung carcinoids, even small ones.