title: Atypical carcinoid tumours of the lung: prognostic factors and patterns of recurrence.
abstract: BACKGROUND
  Atypical carcinoids (AC) of the lung are rare intermediate-grade neuroendocrine neoplasms. Prognostic factors for these tumours are undefined.
  
  
  METHODS
  Our cooperative group retrieved data on 127 patients operated between 1980 and 2009 because of an AC. Several clinical and pathological features were studied.
  
  
  RESULTS
  In a univariable analysis, T-status (p=0.005), N-status (p=0.021), preoperative M-status (previously treated) (p=0.04), and distant recurrence developed during the outcome (p<0.001) presented statistically significant differences related to survival of these patients. In a multivariable analysis, only distant recurrence was demonstrated to be an independent risk factor for survival (p<0.001; HR: 13.1). During the monitoring, 25.2% of the patients presented some kind of recurrence. When we studied recurrence factors in a univariable manner, sublobar resections presented significant relationship with locoregional recurrence (p<0.001). In the case of distant recurrence, T and N status presented significant differences. Patients with preoperative M1 status presented higher frequencies of locoregional and distant recurrence (p=0.004 and p<0.001, respectively). In a multivariable analysis, sublobar resection was an independent prognostic factor to predict locoregional recurrence (p=0.002; HR: 18.1).
  
  
  CONCLUSIONS
  Complete standard surgical resection with radical lymphadenectomy is essential for AC. Sublobar resections are related to locoregional recurrence, so they should be avoided except for carefully selected patients. Nodal status is an important prognostic factor to predict survival and recurrence. Distant recurrence is related to poor outcome.
authors.affiliation: Department of Thoracic Surgery, University Hospital, Vigo, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Cañizares
authors.affiliation: Department of Thoracic Surgery, University Hospital, Valladolid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Matilla
authors.affiliation: Department of Thoracic Surgery, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Cueto
authors.affiliation: Department of Thoracic Surgery, Reina Sofia University Hospital, Cordoba, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Algar
authors.affiliation: Department of Thoracic Surgery, Ramon y Cajal University Hospital, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Muguruza
authors.affiliation: Department of Thoracic Surgery, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Moreno-Mata
authors.affiliation: Department of Thoracic Surgery, La Princesa Hospital, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Moreno-Balsalobre
authors.affiliation: Department of Thoracic Surgery, General University Hospital, Valencia, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Guijarro
authors.affiliation: Department of Thoracic Surgery, Carlos Haya University Hospital, Malaga, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Arrabal
authors.affiliation: Department of Thoracic Surgery, University Hospital, Vigo, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Garcia-Fontan
authors.affiliation: Department of Thoracic Surgery, University Hospital, Vigo, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Gonzalez-Piñeiro
authors.affiliation: Department of Thoracic Surgery, University Hospital, Valladolid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Garcia-Yuste
mesh_terms: D001706:Biopsy; D001999:Bronchoscopy; D002276:Carcinoid Tumor / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis