Atypical lung carcinoid (AC) is widely accepted to recur more often after radical resection than typical lung carcinoid (TC). However, their recurrence rates have never been compared in a multi-state competing risks model. We retrospectively reviewed files from patients with AC and TC who had been radically resected at our European Neuroendocrine Tumor Society Center of Excellence between 2009 and 2020. We estimated the recurrence rates between the AC and TC patients counting unrelated death as a competing event using Aalen–Johansen estimates and compared them using a multi-state Cox model. Finally, we analyzed all AC and TC recurrences as to resection type, pathological stage, resection margin, recurrence site, and time to recurrence. The study included 217 patients, of whom 194 had TC and 23 had AC. The median follow-up was 9.4 years. The AC patients experienced recurrence at a higher rate (hazard ratio [HR] 16.0, 95% confidence interval [CI] 5.3–47.9,p< 0.001). Correspondingly, the 5- and 10-year recurrence rates were 18% and 32% for AC and merely 1.0% and 2.4% for TC. In patients without nodal involvement, AC recurred at a considerably higher rate (HR 41.2, 95% CI 8.7–194.8,p< 0.001) than TC. In both AC and TC, most recurrences were distant and occurred in patients with a resection margin less than 2 cm. We conclude that AC recurs more often than TC, even in patients without nodal involvement at surgery, suggesting that all AC patients regardless of their pathological stage should undergo close follow-up care after surgery.
非典型肺类癌（AC）被广泛认为在根治性切除术后比典型肺类癌（TC）更易复发。然而，其复发率从未在多状态竞争风险模型中进行过比较。我们回顾性分析了2009年至2020年间在我们欧洲神经内分泌肿瘤学会卓越中心接受根治性切除的AC和TC患者的病历。我们使用Aalen-Johansen估计法，将无关死亡视为竞争事件，估算了AC和TC患者的复发率，并使用多状态Cox模型进行了比较。最后，我们分析了所有AC和TC复发的切除类型、病理分期、切除边缘、复发部位和复发时间。该研究共纳入217例患者，其中194例为TC，23例为AC。中位随访时间为9.4年。AC患者的复发率更高（风险比[HR] 16.0，95%置信区间[CI] 5.3–47.9，p < 0.001）。相应地，AC患者的5年和10年复发率分别为18%和32%，而TC患者仅为1.0%和2.4%。在无淋巴结受累的患者中，AC的复发率显著高于TC（HR 41.2，95% CI 8.7–194.8，p < 0.001）。在AC和TC中，大多数复发为远处复发，且发生在切除边缘小于2 cm的患者中。我们得出结论，AC比TC更易复发，即使在手术时无淋巴结受累的患者中也是如此，这表明无论病理分期如何，所有AC患者在术后都应接受密切随访。
Recurrence Rates and Patterns after Radical Resection of Lung Carcinoids
肿瘤(癌症)患者之家