title: Predictors of Disease-free Survival and Recurrence in Patients with Resected Bronchial Carcinoid Tumors.
abstract: BACKGROUND
  Bronchial carcinoids are characterized by neuroendocrine differentiation and have distinct biological behavior, recurrence patterns, and prognosis compared with adenocarcinomas or squamous cell carcinomas. Because of their often indolent nature, it has been suggested that routine postoperative imaging surveillance may not be warranted in the majority of patients. This study aims to define the factors that predict disease-free survival (DFS) and recurrence after resection of these tumors, with the goal of identifying high-risk patients for whom image surveillance may be warranted.
  
  
  METHODS
  We conducted a retrospective review of a prospective database to identify patients with completely resected bronchial carcinoid tumors. Surgical procedure, histology, pathological stage, follow-up, tumor recurrence, and survival were assessed.
  
  
  RESULTS
  One hundred and forty-two patients were identified. Median age was 62 years and the majority was women (106). Surgical procedures included 20 wedge resections, 10 segmentectomies, 99 lobectomies, 3 bilobectomies, 2 pneumonectomies, 6 sleeve resections, and 2 bronchectomies. Pathologic stages included I (81%), II (10%), III (8%), and IV (1%). With a median follow-up of 31 months, there were seven recurrences. The 5- and 10-year overall survival rates were 92% and 75% and DFS rates were 88% and 72%, respectively. There were 34 patients with atypical carcinoids, and 6 (18%) developed recurrence, compared with 1 recurrence (1%) in the group of 108 patients with typical carcinoids (p = 0.0008). For atypical carcinoid tumors, the 5- and 10-year DFS rates were 72% and 32% versus 92% and 85% in typical carcinoid tumors (p = 0.001). Patients with more advanced tumor stage pT2-4 and pathologic N1/N2 nodal metastases had a significantly decreased 5- and 10-year DFS compared with those with early pT1 stage (p = 0.029) or those without nodal disease (p = 0.043). Multivariate Cox regression analyses showed advancing age (p = 0.001), atypical histology (p = 0.021), and advanced tumor stage (p = 0.047) were significant negative predictors for DFS.
  
  
  CONCLUSIONS
  Long-term survival after resection of bronchial carcinoids is common, especially for patients with typical carcinoid tumors. DFS can be negatively influenced by atypical histology, advanced tumor, and nodal statuses. Efforts at postoperative image surveillance should target those patients with such high-risk factors.
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Nonso C
authors.initials: NC
authors.lastname: Osakwe
authors.affiliation: Department of Pathology, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Navnett
authors.initials: N
authors.lastname: Narula
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Weston G
authors.initials: WG
authors.lastname: Andrews
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Abu
authors.initials: A
authors.lastname: Nasar
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001984:Bronchial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002276:Carcinoid Tumor / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult