Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size

Maria Cattoni, Eric Vallières, Lisa M Brown, Amir A. Sarkeshik, Stefano Margaritora, Alessandra Siciliani, Pier Luigi Filosso, Francesco Guerrera, Andrea Imperatori, Nicola Rotolo, Farhood Farjah, Grace Wandell, Kimberly Costas, Catherine Mann, Michal Hubka, Stephen Kaplan, Alexander S. Farivar, Ralph W. Aye, Brian E. Louie

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors. Methods: We retrospectively analyzed 510 consecutive patients (female/male, 313/197; median age, 61 years; interquartile range, 51-70) undergoing lung resection for a primary neuroendocrine tumor between 2000 and 2015 in 8 centers. Multivariable analysis was performed using a Cox proportional hazard model to identify factors associated with disease-specific survival. A new staging system was proposed on the basis of the results of this analysis. Kaplan-Meier disease-specific survival was analyzed by stage using the proposed and the 7th TNM staging system. Results: Follow-up was completed in 490 of 510 patients at a median of 51 months (interquartile range, 18-99). Histology (G1-typical carcinoid vs G2-atypical carcinoid vs G3-large-cell neuroendocrine carcinoma) and pT were independently associated with survival, but pN was not. After regrouping histology and pT, we proposed the following staging system: IA (pT1-2G1), IB (pT3G1, pT1G2), IIA (pT4G1, pT2-3G2, pT1G3), IIB (pT4G2, pT2-3G3), and III (pT4G3). The 5-year survivals were 97.9%, 81.0%, 69.1%, 51.8%, and 0%, respectively. By using the 7th TNM, 5-year survivals were 95.0%, 92.3%, 67.7%, 70.9%, and 65.1% for stage IA, IB, IIA, IIB, and III, respectively. Conclusions: Incorporating histology and regrouping tumor stage create a unique neuroendocrine tumor staging system that seems to predict survival better than the 7th TNM classification.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - 2017
Externally publishedYes

Fingerprint

Neuroendocrine Tumors
Neoplasm Staging
Histology
Lung
Survival
Neoplasms
Carcinoid Tumor
Neuroendocrine Carcinoma
Large Cell Carcinoma
Proportional Hazards Models
Non-Small Cell Lung Carcinoma

Keywords

  • Neuroendocrine tumors
  • Outcomes
  • Pulmonary carcinoid
  • Staging system
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size. / Cattoni, Maria; Vallières, Eric; Brown, Lisa M; Sarkeshik, Amir A.; Margaritora, Stefano; Siciliani, Alessandra; Filosso, Pier Luigi; Guerrera, Francesco; Imperatori, Andrea; Rotolo, Nicola; Farjah, Farhood; Wandell, Grace; Costas, Kimberly; Mann, Catherine; Hubka, Michal; Kaplan, Stephen; Farivar, Alexander S.; Aye, Ralph W.; Louie, Brian E.

In: Journal of Thoracic and Cardiovascular Surgery, 2017.

Research output: Contribution to journalArticle

Cattoni, M, Vallières, E, Brown, LM, Sarkeshik, AA, Margaritora, S, Siciliani, A, Filosso, PL, Guerrera, F, Imperatori, A, Rotolo, N, Farjah, F, Wandell, G, Costas, K, Mann, C, Hubka, M, Kaplan, S, Farivar, AS, Aye, RW & Louie, BE 2017, 'Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2017.08.102
Cattoni, Maria ; Vallières, Eric ; Brown, Lisa M ; Sarkeshik, Amir A. ; Margaritora, Stefano ; Siciliani, Alessandra ; Filosso, Pier Luigi ; Guerrera, Francesco ; Imperatori, Andrea ; Rotolo, Nicola ; Farjah, Farhood ; Wandell, Grace ; Costas, Kimberly ; Mann, Catherine ; Hubka, Michal ; Kaplan, Stephen ; Farivar, Alexander S. ; Aye, Ralph W. ; Louie, Brian E. / Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size. In: Journal of Thoracic and Cardiovascular Surgery. 2017.
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abstract = "Objective: Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors. Methods: We retrospectively analyzed 510 consecutive patients (female/male, 313/197; median age, 61 years; interquartile range, 51-70) undergoing lung resection for a primary neuroendocrine tumor between 2000 and 2015 in 8 centers. Multivariable analysis was performed using a Cox proportional hazard model to identify factors associated with disease-specific survival. A new staging system was proposed on the basis of the results of this analysis. Kaplan-Meier disease-specific survival was analyzed by stage using the proposed and the 7th TNM staging system. Results: Follow-up was completed in 490 of 510 patients at a median of 51 months (interquartile range, 18-99). Histology (G1-typical carcinoid vs G2-atypical carcinoid vs G3-large-cell neuroendocrine carcinoma) and pT were independently associated with survival, but pN was not. After regrouping histology and pT, we proposed the following staging system: IA (pT1-2G1), IB (pT3G1, pT1G2), IIA (pT4G1, pT2-3G2, pT1G3), IIB (pT4G2, pT2-3G3), and III (pT4G3). The 5-year survivals were 97.9{\%}, 81.0{\%}, 69.1{\%}, 51.8{\%}, and 0{\%}, respectively. By using the 7th TNM, 5-year survivals were 95.0{\%}, 92.3{\%}, 67.7{\%}, 70.9{\%}, and 65.1{\%} for stage IA, IB, IIA, IIB, and III, respectively. Conclusions: Incorporating histology and regrouping tumor stage create a unique neuroendocrine tumor staging system that seems to predict survival better than the 7th TNM classification.",
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T1 - Improvement in TNM staging of pulmonary neuroendocrine tumors requires histology and regrouping of tumor size

AU - Cattoni, Maria

AU - Vallières, Eric

AU - Brown, Lisa M

AU - Sarkeshik, Amir A.

AU - Margaritora, Stefano

AU - Siciliani, Alessandra

AU - Filosso, Pier Luigi

AU - Guerrera, Francesco

AU - Imperatori, Andrea

AU - Rotolo, Nicola

AU - Farjah, Farhood

AU - Wandell, Grace

AU - Costas, Kimberly

AU - Mann, Catherine

AU - Hubka, Michal

AU - Kaplan, Stephen

AU - Farivar, Alexander S.

AU - Aye, Ralph W.

AU - Louie, Brian E.

PY - 2017

Y1 - 2017

N2 - Objective: Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors. Methods: We retrospectively analyzed 510 consecutive patients (female/male, 313/197; median age, 61 years; interquartile range, 51-70) undergoing lung resection for a primary neuroendocrine tumor between 2000 and 2015 in 8 centers. Multivariable analysis was performed using a Cox proportional hazard model to identify factors associated with disease-specific survival. A new staging system was proposed on the basis of the results of this analysis. Kaplan-Meier disease-specific survival was analyzed by stage using the proposed and the 7th TNM staging system. Results: Follow-up was completed in 490 of 510 patients at a median of 51 months (interquartile range, 18-99). Histology (G1-typical carcinoid vs G2-atypical carcinoid vs G3-large-cell neuroendocrine carcinoma) and pT were independently associated with survival, but pN was not. After regrouping histology and pT, we proposed the following staging system: IA (pT1-2G1), IB (pT3G1, pT1G2), IIA (pT4G1, pT2-3G2, pT1G3), IIB (pT4G2, pT2-3G3), and III (pT4G3). The 5-year survivals were 97.9%, 81.0%, 69.1%, 51.8%, and 0%, respectively. By using the 7th TNM, 5-year survivals were 95.0%, 92.3%, 67.7%, 70.9%, and 65.1% for stage IA, IB, IIA, IIB, and III, respectively. Conclusions: Incorporating histology and regrouping tumor stage create a unique neuroendocrine tumor staging system that seems to predict survival better than the 7th TNM classification.

AB - Objective: Neuroendocrine tumors of the lung are currently staged with the 7th edition TNM non-small cell lung cancer staging system. This decision, based on data analysis without data on histology or disease-specific survival, makes its applicability limited. This study proposes a specific staging system for these tumors. Methods: We retrospectively analyzed 510 consecutive patients (female/male, 313/197; median age, 61 years; interquartile range, 51-70) undergoing lung resection for a primary neuroendocrine tumor between 2000 and 2015 in 8 centers. Multivariable analysis was performed using a Cox proportional hazard model to identify factors associated with disease-specific survival. A new staging system was proposed on the basis of the results of this analysis. Kaplan-Meier disease-specific survival was analyzed by stage using the proposed and the 7th TNM staging system. Results: Follow-up was completed in 490 of 510 patients at a median of 51 months (interquartile range, 18-99). Histology (G1-typical carcinoid vs G2-atypical carcinoid vs G3-large-cell neuroendocrine carcinoma) and pT were independently associated with survival, but pN was not. After regrouping histology and pT, we proposed the following staging system: IA (pT1-2G1), IB (pT3G1, pT1G2), IIA (pT4G1, pT2-3G2, pT1G3), IIB (pT4G2, pT2-3G3), and III (pT4G3). The 5-year survivals were 97.9%, 81.0%, 69.1%, 51.8%, and 0%, respectively. By using the 7th TNM, 5-year survivals were 95.0%, 92.3%, 67.7%, 70.9%, and 65.1% for stage IA, IB, IIA, IIB, and III, respectively. Conclusions: Incorporating histology and regrouping tumor stage create a unique neuroendocrine tumor staging system that seems to predict survival better than the 7th TNM classification.

KW - Neuroendocrine tumors

KW - Outcomes

KW - Pulmonary carcinoid

KW - Staging system

KW - Survival

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