Survival following resection of 10,244 lung neuroendocrine tumours: a population study

Surgical resection is the primary treatment for lung neuroendocrine tumours (NET) but the optimal follow-up is unclear. This is a population-based analysis of 3,307 patients from England (NCRAS database; 2012-2021) and 6,937 patients from the United States (SEER database; 2003-2022) who underwent surgical resection for lung NET, which explores factors affecting post-surgical survival and optimal follow-up duration in these patients. Kaplan-Meier (KM) analysis estimated overall survival (OS). Cox proportional hazards models identified factors affecting survival. Patients were matched to national life tables (UK and US) by age, sex, and year of diagnosis to compare actual versus expected KM plots. In NCRAS, OS at 1, 3, 5, and 10 years was 99.6, 95.3, and 91.2% respectively, and in SEER 99.7, 95.5, and 91.8% respectively. In both England and the US, most patients presented with stage 1 disease. Multivariable Cox regression analyses showed that increasing age, advanced stage, socioeconomic deprivation, and atypical carcinoid morphology were associated with worse survival in both countries. In addition, in the US, male sex and pneumonectomy or wedge resection were also associated with worse survival. No overlap was observed between actual and expected KM plots in England, either overall or in subgroups of stage 1, typical morphology, or tumour <2 cm. In the US, an overlap was observed between actual and expected KM plots for the overall cohort at 240 months (20 years). This analysis of two large national cohorts provides information on the survival of lung NET after surgery, which can contribute to future guideline development on long-term follow-up.