The Cancers-Specific Survival of Metastatic Pulmonary Carcinoids and Sites of Distant Metastasis: A Population-Based Study

Abstract

Background: Lung cancer is the leading cause of cancer-related deaths and pulmonary carcinoids (PCs) account for almost 2% of all pulmonary malignancies. However, few published articles have reported prognosis and related factors of pulmonary carcinoid patients. Material and Method: The Surveillance, Epidemiology, and End Results (SEER) database was used to collect data of patients diagnosed with metastatic PCs from 2010 to 2016. The prognosis and survival of these patients were compared by employing Cox proportional hazards and the Kaplan-Meier survival analysis. Results: A total of 1763 patients were analyzed. The liver (668, 25.6%) was shown to be the most common metastatic site in the isolated organ metastasis cohort, followed by the lung (636, 24.4%), bone (562, 21.6%), and brain (460, 17.6%). Among the patients, the tumor metastasized to a single distant site included the liver, bone, lung, and brain. Cancer-specific survival (CSS) in metastatic PCs is determined by the site of metastasis and the total number of such sites. Pulmonary carcinoid patients with isolated liver metastasis manifested more favorable survival rates in comparison to patients having isolated metastasis in the lung, brain, or bone. The median CSS was 45, 7, 6, 5 months ( P = 0.011). The number of distant metastatic sites and the location of distant metastasis were found to be independent risk factors for CSS. For patients with distant isolated metastasis, liver metastasis ( P < 0.0001) had better CSS in comparison to those with bone metastasis. When compared to patients whose carcinoids had metastasized to the bones, patients with a brain ( P = 0.273) or lung ( P = 0.483) metastasis had the same CSS. Conclusion: Cancer-specific survival in metastatic PCs depends on the site of metastasis and the total number of such locations. PC patients with isolated liver metastasis manifested more favorable survival in comparison to patients with isolated metastasis in the lung, brain, or bone.

Surgery of primary lung carcinoid tumors at metastatic stage: A national study from the French Group of Endocrine Tumors (GTE) and ENDOCAN‐RENATEN network

“…23 This difference between the present study and that reported by Zhang et al may be explained by a lack of power of our study, but also because the study reported by Zhang et al was not designed to specifically evaluate the impact of surgery on OS, in including a multiplicity of comparisons. 23 As reported herein, patients in the operative and nonoperative groups were different by definition;…”

“…The OS was significantly higher in the operative group, but this benefit was not significantly higher after multivariate analysis and adjustment on confounding factors, as was found for metastatic pancreatic and small intestinal NETs elsewhere 17–19 . However, in the study reported by Zhang et al, including 1763 patients from the US SEER database, surgery for metastatic L‐NETs was a factor associated with good prognosis in terms of cancer‐specific survival in univariate and multivariate analysis 23 . This difference between the present study and that reported by Zhang et al may be explained by a lack of power of our study, but also because the study reported by Zhang et al was not designed to specifically evaluate the impact of surgery on OS, in including a multiplicity of comparisons 23 .…”

“…However, in the study reported by Zhang et al, including 1763 patients from the US SEER database, surgery for metastatic L‐NETs was a factor associated with good prognosis in terms of cancer‐specific survival in univariate and multivariate analysis 23 . This difference between the present study and that reported by Zhang et al may be explained by a lack of power of our study, but also because the study reported by Zhang et al was not designed to specifically evaluate the impact of surgery on OS, in including a multiplicity of comparisons 23 . As reported herein, patients in the operative and nonoperative groups were different by definition; for example, patients in the nooperative group herein had significantly a worse PS and a greater number of metastatic sites, which were both significantly associated with survival.…”

“…As reported herein, patients in the operative and nonoperative groups were different by definition; for example, patients in the nooperative group herein had significantly a worse PS and a greater number of metastatic sites, which were both significantly associated with survival. We therefore believe that no conclusion can be made on the benefit of surgery based on the study reported by Zhang et al 23 and that the impact of removal the primary tumor for metastatic L‐NETs remains to be determined.…”

“…22 An interesting point highlighted herein is that, even if not clearly recommended in international guidelines, surgery of the primary L-NET is often performed at the metastatic stage; just over a quarter of patients underwent surgery, which is higher than a larger study that included 1763 patients from the US Surveillance, Epidemiology, and End Results (SEER) database and in which 8.6% patients underwent surgery. 23 This could be explained by the recruitment herein from tertiary centers where more complex procedures, such as the thoracic surgery, are usually performed, although we do not recommend pneumonectomy (performed herein in 3 patients) for metastatic L-NETs.…”