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. Evangelista; Guerrera, F.; Thomas, P.; Welter, S.; Moreno Casado, P.; Venuta, F.; Rendina, E.; Brunelli, A.; Ampollini, Luca; 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.
