title: Prognostic model of survival for typical bronchial carcinoid tumours: analysis of 1109 patients on behalf of the European Association of Thoracic Surgeons (ESTS) Neuroendocrine Tumours Working Group.
abstract: OBJECTIVE
  Typical carcinoids (TCs) are uncommon, slow-growing neoplasms, usually with high 5-year survival rates. As these are rare tumours, their management is still based on small clinical observations and no international guidelines exist. Based on the European Society of Thoracic Surgeon Neuroendocrine Tumours Working Group (NET-WG) Database, we evaluated factors that may influence TCs mortality.
  
  
  METHODS
  Using the NET-WG database, an analysis on TC survival was performed. Overall survival (OS) was calculated starting from the date of intervention. Predictors of OS were investigated using the Cox model with shared frailty (accounting for the within-centre correlation). Candidate predictors were: gender, age, smoking habit, tumour location, previous malignancy, Eastern Cooperative Oncology Group (ECOG) performance status (PS), pT, pN, TNM stage and tumour vascular invasion. The final model included predictors with P ≤ 0.15 after a backward selection. Missing data in the evaluated predictors were multiple-imputed and combined estimates were obtained from five imputed data sets.
  
  
  RESULTS
  For 58 of 1167 TC patients vital status was unavailable and analyses were therefore performed on 1109 patients from 17 institutions worldwide. During a median follow-up of 50 months, 87 patients died, with a 5-year OS rate of 93.7% (95% confidence interval: 91.7-95.3). Backward selection resulted in a prediction model for mortality containing age, gender, previous malignancies, peripheral tumour, TNM stage and ECOG PS. The final model showed a good discrimination ability with a C-statistic equal to 0.836 (bootstrap optimism-corrected 0.806).
  
  
  CONCLUSIONS
  We presented and validated a promising prognostic model for TC survival, showing good calibration and discrimination ability. Further analyses are needed and could be focused on an external validation of this model.
authors.affiliation: Department of Thoracic Surgery, University of Torino, Torino, Italy pierluigi.filosso@unito.it.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.affiliation: Department of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guerrera
authors.affiliation: Unit of Cancer Epidemiology and CPO Piedmont, S. Giovanni Battista Hospital, Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Division of Thoracic Surgery, Ruhrlandklinik, Essen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Welter
authors.affiliation: Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, Aix-Marseille University and Hospitals System of Marseille (AP-HM), Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Department of Thoracic Surgery, University Hospital 'Reina Sofia', Cordoba, Spain.
authors.forename: Paula Moreno
authors.initials: PM
authors.lastname: Casado
authors.affiliation: Fondazione Eleonora Lorillard Spencer Cenci, Sapienza University of Rome, Rome, Italy.
authors.forename: Erino Angelo
authors.initials: EA
authors.lastname: Rendina
authors.affiliation: Fondazione Eleonora Lorillard Spencer Cenci, Sapienza University of Rome, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.affiliation: Unit of Thoracic Surgery, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ampollini
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: Unit of Thoracic Surgery, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Stella
authors.affiliation: Unit of Thoracic Surgery, Ospedale Maggiore Policlinico, University of Milano, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Nosotti
authors.affiliation: Unit of Thoracic Surgery, Azienda Ospedaliera S. Paolo, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Raveglia
authors.affiliation: Unit of Thoracic Surgery, Ospedale 'Spirito Santo' Azienda ASL di Pescara, Pescara, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Larocca
authors.affiliation: Unit of Thoracic Surgery, 'Amedeo Avogadro' University of Eastern Piedmont, Novara, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Rena
authors.affiliation: Unit of Thoracic Surgery, Catholic University 'Sacred Heart', Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.affiliation: Unit of Thoracic Surgery, Azienda Ospedaliero-Universitaria 'San Luigi' Orbassano, University of Torino, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardissone
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Travis
authors.affiliation: Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Inderpal
authors.initials: I
authors.lastname: Sarkaria
authors.affiliation: Department of Thoracic Surgery, Medical University of Lublin, Lublin, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Sagan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001984:Bronchial Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Lung; Metastases; Neuroendocrine tumours; Prognostic score; Recurrence; Surgery; Survival; Typical carcinoid