Top

General Thoracic and Cardiovascular Surgery

Published in:

01-05-2020 | Carcinoid Tumor | Original Article

Pulmonary carcinoid tumours: incidence, histology, and surgical outcome. A population-based study

Authors: Astridur Petursdottir, Johanna Sigurdardottir, Bjorn M. Fridriksson, Arni Johnsen, Helgi J. Isaksson, Hronn Hardardottir, Steinn Jonsson, Tomas Gudbjartsson

Published in: General Thoracic and Cardiovascular Surgery | Issue 5/2020

Abstract

Background

Pulmonary carcinoids (PCs) represent only a minority of all primary pulmonary malignancies but they are the most common type of pulmonary malignancy diagnosed in children and adolescents. In this nationwide study, we analyzed data on all PC tumours in the Icelandic population over a 60-year period and concentrated especially on incidence and patient outcomes.

Methods

We studied all cases of PCs diagnosed in Iceland in the period 1955‒2015. Histological specimens were re-evaluated and the tumours were staged according to the TNM system (seventh edition). Survival was estimated using the Kaplan–Meier method, with a mean follow-up of 15.7 years.

Results

Altogether, 88 patients (median age 51.0 years, 65.9% women) were diagnosed with PCs in the study period. The incidence increased from 0.19/100,000/year in the first decade (1955‒1964) to 0.58/100,000/year in the last decade (2005‒2015), with a mean increase of 29.0% per decade of the study period (p < 0.001). The rise in incidental detection was, however, not significant. The median tumour diameter was 2.2 cm (range 0.4‒7.0) and typical histology was seen in 74 patients (84.1%). The other 14 patients (15.9%) had atypical histology. In all, 90.9% of the patients underwent pulmonary resection, 81.2% of them with lobectomy, with all of them surviving at least 30 days postoperatively. Most patients (n = 52, 62.7%) were stage IA at diagnosis, 15 (18.1%) were stage IB, nine (10.8%) were stage IIA, and three were stage IIIA (3.6%). Four patients (4.8%) had distant metastases (stage IV), two of whom had typical histology. Five-year survival was 89.8% for all patients: 93.2% for patients with typical histology and 70.7% for those with atypical histology.

Conclusion

The incidence of PCs in Iceland has increased significantly over the last six decades, which cannot be explained by a rise in incidental detection at chest imaging. Most patients have localized disease and a favourable histology, where the long-term outcome is excellent.

Naalsund AR, Strom E, Lund M, Strand TE. Carcinoid lung tumors—incidence, treatment and outcomes: a population-based study. Eur J Cardiothorac Surg. 2011;39:565–9.PubMed

Skuladottir HH, Hansen H, Olsen J. Pulmonary neuroendocrine tumors: Incidence and prognosis of histological subtypes. A population-based study in Denmark. Lung Cancer. 2002;37(2):127–35.PubMed

Rekhtman N. Neuroendocrine tumors of the lung: an update. Arch Pathol Lab Med. 2010;134(11):1628–38.PubMed

Hallgrimsson J, Jonsson T, Johannsson J. Bronchopulmonary carcinoids in Iceland 1955–1984. A retrospective clinical and histopathologic study. Scand J Thorac Cardiovasc Surg. 1989;23(3):275–8.PubMed

Gatta G, Ciccolallo L, Kunkler I, Capocaccia R, Berrino F, Coleman M, et al. Survival from rare cancer in adults: a population-based study. Lancet Oncol. 2006;7(2):132–40.PubMed

Alsina M, Marcos-Gragera R, Capdevila J, Buxó M, Ortiz R, Barretina P, et al. Neuroendocrine tumors: a population-based study of incidence and survival in Girona Province, 1994–2004. Cancer Epidemiol. 2011;35(6):49–544.

Fink G, Krelbaum T, Yellin A, Bendayan D, Saute M, Glazer M, et al. Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest. 2001;119(6):1647–51.PubMed

Hauso O, Gustafsson B, Kidd M, Waldum H, Drozdov I, Chan A, et al. Neuroendocrine tumor epidemiology: contrasting Norway and North America. Cancer. 2008;113(10):2655–64.PubMed

Levi F, Te V, Randimbison L, Rindi G, La Vecchia C. Epidemiology of carcinoid neoplasms in Vaud, Switzerland, 1974–97. Br J Cancer. 2000;83(7):952–5.PubMedPubMedCentral

10.

Modlin I, Lye K, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003;97(4):934–59.PubMed

11.

Yao J, Hassan M, Phan A, Dagohoy C, Leary C, Mares J, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063–72.PubMed

12.

Hemminki K, Li X. Familial carcinoid tumors and subsequent cancer: a nation-wide epidemiologic study from Sweden. Int J Cancer. 2001;94(3):444–8.PubMed

13.

Hemminki K, Li X. Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden. Cancer. 2001;92(8):2204–10.PubMed

14.

Hassan M, Phan A, Li D, Dagohoy C, Leary C, Yao J. Risk factors associated with neuroendocrine tumors: A U.S.-based case-control study. Int J Cancer. 2008;123(4):867–73.PubMed

15.

Filosso P, Rena O, Donati G, Casadio C, Ruffini E, Papalia E, et al. Bronchial carcinoid tumors: surgical management and long-term outcome. J Thorac Cardiovasc Surg. 2002;123(2):303–9.PubMed

16.

Hartman G, Schochat S. Primary pulmonary neoplasms of childhood: a review. Ann Thorac Surg. 1983;36(1):108–19.PubMed

17.

Wang L, Wilkins EJ, Bode H. Bronchial carcinoid tumors in pediatric patients. Chest. 1993;103(5):1426–8.PubMed

18.

Travis W, Brambilla E, Müller-Hermelink H, Harris C, editors. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004.

19.

Arrigoni M, Woolner L, Bernatz P. Atypical carcinoid tumors of the lung. J Thorac Cardiovasc Surg. 1972;64(3):413–21.PubMed

20.

Travis W, Colby T, Corrin B, Shimosato Y, Brambilla E. Histological typing of lung and pleural tumours. New York: Springer; 1999.

21.

Lim E, Yap Y, De Stavola B, Nicholson A, Goldstraw P. The impact of stage and cell type on the prognosis of pulmonary neuroendocrine tumors. J Thorac Cardiovasc Surg. 2005;130(4):969–72.PubMed

22.

Cao C, Yan T, Kennedy C, Hendel N, Bannon P, McCaughan B. Bronchopulmonary Carcinoid Tumors: Long-term outcomes after resection. Ann Thorac Surg. 2011;91(2):339–43.PubMed

23.

Sigurdardottir J, Isaksson H, Johannsson K, Jonsson S, Gudbjartsson T. Vefjagerð krabbalíkisæxla í lungum spáir ekki fyrir um klíníska hegðum - Niðurstöður úr íslenskri rannsókn. Icelandic Med J. 2008;94(2):125–30.

24.

Froudarakis M, Fournel P, Burgard D, Bouros D, Boucheron S, Siafakas N, et al. Bronchial carcinoids. A review of 22 cases. Oncology. 1996;53(2):152–8.

25.

Bertino E, Confer P, Colonna J, Ross P, Otterson G. Pulmonary neuroendocrine/carcinoid tumors: a review article. Cancer. 2009;115:4434–41.PubMed

26.

Caplin M, Baudin E, Ferolla P, Filosso P, Garcia-Yuste M, Lim E, et al. Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. Ann Oncol. 2015;26(8):1604–20.PubMed

27.

Edge S, Byrd D, Compton C, Fritz A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

28.

Anderson R, Rosenberg H. Age standardization of death rates: implementation of the year 2000 standard. Natl Vital Stat Rep. 1998;47(3):1–16 (20).PubMed

29.

Keshgegian A, Wheeler J. Estrogen receptor protein in malignant carcinoid tumor. Cancer. 1980;45:293–6.PubMed

30.

Gustafsson B, Kidd M, Chan A, Malfertheiner M, Modlin I. Bronchopulmonary neuroendocrine tumors. Cancer. 2008;113:5–21.PubMed

31.

Greenberg R, Baumgarten B, Clark W, Isacson P, McKeen K. Prognostic factors for gastrointestinal and bronchopulmonary tumors. Cancer. 1987;60:2476–83.PubMed

32.

Soga J, Yakuwa Y. Bronchopulmonary carcinoids: an analysis of 1,875 reported cases with special reference to a comparison between typical carcinoids and atypical varieties. Ann Thorac Cardiovasc Surg. 1999;5:211–9.PubMed

33.

Kayser K, Kayser C, Rahn W, Bovin N, Gabius H. Carcinoid tumors of the lung: immuno- and ligandohistochemistry, analysis of integrated optical density, syntactic structure analysis, clinical data, and prognosis of patients treated surgically. J Surg Oncol. 1996;63(2):99–106.PubMed

34.

Schlüter C, Duchrow M, Wohlenberg C, Becker M, Key G, Flad H, et al. The cell proliferation-associated antigen of antibody Ki-67: a very large, ubiquitous nuclear protein with numerous repeated elements, representing a new kind of cell cycle-maintaining proteins. J Cell Biol. 1993;123(3):513–22.PubMed

35.

Rindi G, Klöppel G, Alhman H, Caplin M, Couvelard A, de Herder W, et al. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch. 2006;449(4):395–401.PubMedPubMedCentral

36.

Guiu S, Michiels S, Andre F, Cortes J, Denkert C, Di Leo A, et al. Molecular subclasses of breast cancer: how do we define them? The IMPAKT 2012 Working Group Statement. Ann Oncol. 2012;23(12):2997–3006.PubMed

37.

Travis W, Brambilla E, Burke A, Marx A, Nicholson A, editors. WHO classification of tumours of the lung, pleura, thymus and heart. 4th ed. Lyon: World Health Organization Classification of Tumours. 4. útg. IARC Press; 2015.

38.

Travis W, Brambilla E, Nicholson A, Yatabe Y, Austin J, Beasley M, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10(9):1243–60.PubMed

39.

Travis W, Giroux D, Chansky K, Crowley J, Asamura H, Brambilla E, et al. The IASLC Lung Cancer Staging Project: proposals for the inclusion of broncho-pulmonary carcinoid tumors in the forthcoming (seventh) edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2008;3(11):1213–23.PubMed

40.

Cattoni M, Vallieres E, Brown L, Sakeshik A, Margaritora S, Siciliani A, et al. Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size. J Thorac Cardiovasc Surg. 2018;155(1):405–13.PubMed

41.

Lee M-C, Aly R, Adusumilli P. New staging system for pulmonary neuroendocrine tumors: a clinical and pathologic necessity. J Thorac Cardiovasc Surg. 2018;155(1):367–8.PubMed

42.

Kay F, Kandathil A, Batra K, Saboo S, Abbara S, Rajiah P. Revisions to the tumor, node, metastasis staging of lung cancer (8th edition): rationale, radiologic findings and clinical implications. World J Radiol. 2017;9(6):269–79.PubMedPubMedCentral

43.

Ferguson M, Landreneau R, Hazelrigg S, Altorki N, Naunheim K, Zwischenberger J, et al. Long-term outcome after resection for bronchial carcinoid tumors. Eur J Cardiothorac Surg. 2000;18(2):156–61.PubMed

44.

Sadowski S, Christ E, Bedat B, Kollar A, Karenovics W, Perren A, et al. Nationwide multicenter study on the management of pulmonary endocrine (carcinoid) tumors. Endocr Connect. 2018;7(1):8–15.PubMed

Title: Pulmonary carcinoid tumours: incidence, histology, and surgical outcome. A population-based study
Authors: Astridur Petursdottir
Johanna Sigurdardottir
Bjorn M. Fridriksson
Arni Johnsen
Helgi J. Isaksson
Hronn Hardardottir
Steinn Jonsson
Tomas Gudbjartsson
Publication date: 01-05-2020
Publisher: Springer Singapore
Keyword: Carcinoid Tumor
Published in: General Thoracic and Cardiovascular Surgery / Issue 5/2020
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-019-01261-w

At a glance: The STEP trials

Springer Medicine

Pulmonary carcinoid tumours: incidence, histology, and surgical outcome. A population-based study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2020

Surgical treatment of multiple coronary-to-pulmonary artery fistulas with severe coronary artery stenosis

Potential benefit of non-cardiac arrested thromboembolectomy of acute pulmonary embolism for the impaired right ventricular function

High mean platelet volume to platelet count ratio as a predictor on poor outcomes after CABG

The impact of surgical chest wall damage caused by classic thoracotomy on pulmonary function and morphology

Mid-term results of valve repairs for atrial functional mitral and tricuspid regurgitations

Resection of intra-pulmonary endometriosis by video-assisted thoracoscopic surgery under pre-operative CT-guided marking synchronized with menstrual cycle