Clinical Characteristics And Prognostic Analysis Of Primary Pulmonary Carcinoid Tumors

Objective:The number of deaths from lung cancer ranks first in all kindsof cancer in China. Pulmonary Carcinoid Tumors is a special kind ofpathological types in pulmonary cancer, the incidence of which accounted foronly1%-2%of primary lung tumors[2]. At present, not only the knowledgeabout pulmonary carcinoid tumors but also the influence factors of lungcarcinoid patients’ survival rate after the operation have less investigation.This research intends to retrospectively study and analysis the clinicalcharacteristics of pulmonary carcinoid, and discusses the key factors of theinfluence in the prognosis of surgical treatment for pulmonary carcinoidpatients.Methods:Retrospective analysis of the clinical data in detail of31casesof postoperative pathologic diagnosis of pulmonary carcinoid patients treatedin fourth hospital, Hebei medical university from May2002to May2002,which included14cases of typical carcinoid (TC),17cases of atypicalcarcinoid (AC). The31cases included14males and17females, aged from31to74years old, with the median age of54, and ten of them had smokinghistory, which are all men. The average time of onset is40days. There is onecase associated with renal granular cell carcinoma, and no patientscomplicated with carcinoid syndrome. The examination results showed9cases have the tumor located in the left upper lobe, with5cases of central type;6cases located in the left lower lobe, with4of central type;1case located inthe left main bronchus;4cases located in the right upper lobe, with2ofcentral type;3cases located in the right middle lobe, with2of central type;8cases located in the right lower lobe, with6of central type. Tumors had thelargest diameter ranged from2cm to18cm and the average is4.3cm. Allpatients were subjected to surgical treatment mainly by lobectomy. Left lung lobectomy in6cases, left upper lobe resection and left lower lobe bronchussleeve shape forming technique in1case, left upper lobe wedge resection in2cases, left lower lobe resection in5cases, the left lower lobe lung wedgeresection in1case, left pneumonectomy in1case.4cases of resection of theupper lobe, right pulmonary lobectomy4cases, right lung middle loberesection in6cases, the middle of the right lung wedges resection in1case.2patients underwent routine preoperative chemotherapy, and9did routinepostoperative adjuvant therapy,8of which underwent chemotherapy aftersurgery, and1did routine postoperative radiotherapy.30cases underwentsurrounding lymph node cleaning after operation, and7cases of patients hadperipheral lymph node metastasis, with the metastasis rate of22.6%. Thenumber of the lymph node we cleaned is a total of276, with the average of8.90, and18metastasis lymph nodes, with the degree of lymph nodemetastasis of6.5%. All patients did not have surgery and perioperative death,and the entire postoperative specimen had pathology examination.19patientshad postoperative pathological immunohistochemical examination, and theremaining patients borrow pathology slides parallel immunohistochemicalexamination review at the beginning of the study. To determine the tumorpathological stage based on the International Union Against Cancer (UICC)TNM staging (2011), we have18cases in phase I,9in phase II,4in phase III,0in phase IV. The shortest period of survival of patients with postoperativereturn visit was8months (+), up to122(+), with a median survival time of61months, with an average survival time of55.2months. Use SPSS13.0softwarefor data analysis, Logrank method for significant test of survival rate betweeneach group, Kaplan-meier method to calculate survival rate, Cox proportionalhazards regression model to univariate and multivariate analysis, life tablemethod to calculate survival rate. Each statistical calculations of the P value isless than0.05, the survival difference was statistically significant.Respectively from9data such as the age of onset, gender, smoking history,tumor size, tumor location, whether associated with lymph node metastasis,pathological type (immunohistochemistry), pathological TNM staging and postoperative or without adjuvant therapy etc. for univariate and multivariateprognostic analyzes.Results:All patients with1-year,3-year,5-year survival rates were90.3%,67.7%and54.8%respectively, which were higher than other types oflung cancer. Log-rank examination showed that patients with differentpathological types and different clinical stage have the survival difference of1-year,3-year,5-year was statistically significant. Cox proportional hazardsregression model univariate analysis showed that the pathological type (P=0.022), pathological TNM stage (P=0.012), tumor size (P=0.045), with orwithout lymph node metastasis (P=0.027) are the factors which influencedprognosis. Cox proportional hazards regression model of multi-factor analysisshowed that tumor pathological type (P=0.004) and pathology TNM staging(P=0.003) were independent factors affecting the prognosis.Conclusion:Primary pulmonary carcinoid postoperative survival rate ishigher than other types of lung cancer, the diagnosis relies mainly on thepostoperative pathological diagnosis, and radical surgery is the main treatment.There was no statistically significant difference of survival among the groupsof sex, age, smoking history, tumor location, and postoperative cases ofradiation and chemotherapy. Postoperative pathological types, postoperativepathologic staging of lung carcinoid, the size of pulmonary carcinoid tumors,whether the lung carcinoid associated with lymph node metastasis are theinfluence factors of lung carcinoid patients postoperative survival rate, inwhich the postoperative pathological type and pathological staging of lungcarcinoid patients postoperative survival rate are independent factors.