Objectives: Atypical Carcinoids (ACs) of the lung are uncommon neoplasms with a biological behavior still not entirely understood. The efficacy of adjuvant regimens remains unclear, since these tumours do not seem completely responsive to chemo-radiotherapy. Moreover, local or distant relapses are not unusual in ACs. The aim of this study is to evaluate the impact of adjuvant treatment in resected ACs. Methods: This is a retrospective study, including ACs operated between 1992 and 2012 in 17 institutions worldwide. Stage I tumours were excluded from the analysis. Overall survival (OS), calculated from date of resection, was estimated by the Kaplan-Meier method. Propensity score (PS) for the likelihood of having undergone adjuvant chemotherapy (CT) was estimated based on the following variables: age, gender, smoking history, previous malignancy, ECOG performance score (ECOG-PS), pTNM stage, resection status and year of surgery. PS-adjusted and multivariable-adjusted OS comparisons by adjuvant chemotherapy were assessed using the Cox regression model. Results: Overall, the final analysis comprised 75 cases: 19 (25%) received adjuvant chemotherapy. The median follow-up (FU) was 51 months; FU completeness was 89%. At the end of the study, 24 patients died (5 in the CT group). Patients receiving adjuvant-CT showed a slightly better survival (HR 0.80, P = 0.66). PS-adjusted analyses demonstrated no significative effect of adjuvant chemotherapy on OS (adjuvant-CT yes vs no HR: 0.97, 95% CI 0.34-2.79, P = 0.95). Sensitive analysis performed using multivariable Cox model showed similar results (HR 1.06, 95% CI 0.29-3.76 P = 0.93). Age and advanced pTNM stages were independent predictors. Conclusion: Our results did not demonstrate any significant advantage of adjuvant chemotherapy on survival in resected ACs. Multi-institutional randomized clinical trials are needed to find the optimal treatment for advanced-stage tumours.
THE IMPACT OF ADJUVANT CHEMOTHERAPY IN ATYPICAL CARCINOID OF THE LUNG. A PROPENSITY SCORE ANALYSIS OF THE EUROPEAN SOCIETY OF THORACIC SURGEONS LUNG NEUROENDOCRINE DATABASE / Pier Luigi Filosso, A.E., Guerrera, F., Thomas, P., Welter, S., Moreno Casado, P., Venuta, F., Rendina, E., Brunelli, A., Ampollini, L., Ardissone, F., Travis, W., Nosotti, M., Sagan, D., Raveglia, F., Rena, O., Margaritora, S.. - In: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY. - ISSN 1569-9293. - 21:Supplemento 1(2015). [10.1093/icvts/ivv204.01]
THE IMPACT OF ADJUVANT CHEMOTHERAPY IN ATYPICAL CARCINOID OF THE LUNG. A PROPENSITY SCORE ANALYSIS OF THE EUROPEAN SOCIETY OF THORACIC SURGEONS LUNG NEUROENDOCRINE DATABASE
AMPOLLINI, Luca;
2015-01-01
Abstract
Objectives: Atypical Carcinoids (ACs) of the lung are uncommon neoplasms with a biological behavior still not entirely understood. The efficacy of adjuvant regimens remains unclear, since these tumours do not seem completely responsive to chemo-radiotherapy. Moreover, local or distant relapses are not unusual in ACs. The aim of this study is to evaluate the impact of adjuvant treatment in resected ACs. Methods: This is a retrospective study, including ACs operated between 1992 and 2012 in 17 institutions worldwide. Stage I tumours were excluded from the analysis. Overall survival (OS), calculated from date of resection, was estimated by the Kaplan-Meier method. Propensity score (PS) for the likelihood of having undergone adjuvant chemotherapy (CT) was estimated based on the following variables: age, gender, smoking history, previous malignancy, ECOG performance score (ECOG-PS), pTNM stage, resection status and year of surgery. PS-adjusted and multivariable-adjusted OS comparisons by adjuvant chemotherapy were assessed using the Cox regression model. Results: Overall, the final analysis comprised 75 cases: 19 (25%) received adjuvant chemotherapy. The median follow-up (FU) was 51 months; FU completeness was 89%. At the end of the study, 24 patients died (5 in the CT group). Patients receiving adjuvant-CT showed a slightly better survival (HR 0.80, P = 0.66). PS-adjusted analyses demonstrated no significative effect of adjuvant chemotherapy on OS (adjuvant-CT yes vs no HR: 0.97, 95% CI 0.34-2.79, P = 0.95). Sensitive analysis performed using multivariable Cox model showed similar results (HR 1.06, 95% CI 0.29-3.76 P = 0.93). Age and advanced pTNM stages were independent predictors. Conclusion: Our results did not demonstrate any significant advantage of adjuvant chemotherapy on survival in resected ACs. Multi-institutional randomized clinical trials are needed to find the optimal treatment for advanced-stage tumours.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
