title: Defining the role of adjuvant chemotherapy after lobectomy for typical bronchopulmonary carcinoid tumors.
abstract: BACKGROUND
  Treatment guidelines for typical bronchopulmonary carcinoid tumors recommend observation alone after resection of stage I-IIIA disease, but there are limited data related to the use of adjuvant chemotherapy in the setting of nodal metastases found at operation.
  
  
  METHODS
  Patients in the National Cancer Data Base (NDCB) who underwent lobectomy for typical carcinoid and had metastatic nodal disease were stratified by the use of adjuvant chemotherapy. Baseline characteristics and outcomes were compared between groups. Next, patients were propensity matched using a 3:1 nearest-neighbor algorithm, and adjusted outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method with comparisons based on the log-rank test.
  
  
  RESULTS
  Overall, 4,612 patients were identified, among whom 629 (13.6%) had positive lymph nodes at the time of operation. Of them, adjuvant chemotherapy was used in 37 patients (5.9%). There were no baseline differences between patients who did and those who did not receive adjuvant chemotherapy. Patients treated with chemotherapy demonstrated a survival disadvantage at 5 years (69.7% versus 81.9%; p = 0.042). After propensity matching, all baseline characteristics between groups were highly similar. There remained a trend toward inferior 5-year survival for patients who received adjuvant chemotherapy, although the difference no longer met statistical significance (69.7% versus 80.9%; p = 0.096).
  
  
  CONCLUSIONS
  Adjuvant chemotherapy is not associated with improved survival among patients who undergo lobectomy for typical carcinoids and nodal metastases. These data support current treatment guidelines.
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina. Electronic address: daniel.nussbaum@duke.edu.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina; Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
mesh_terms: D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate