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Grade of Differentiation Affects Survival after Lobectomy for Stage-1 Neuroendocrine Lung Cancer
EP25572
Grade of Differentiation Affects Survival after Lobectomy for Stage-1 Neuroendocrine Lung Cancer
Submitted on 17 Feb 2017

Danny T. Nguyen BA, Jacques P. Fontaine MD, Lary A. Robinson MD, Robert J. Keenan MD, Eric M. Toloza MD, PhD
Department of Thoracic Oncology, Moffitt Cancer Center, Departments of Surgery and of Oncologic Sciences University of South Florida Morsani College of Medicine
This poster was presented at USF Health Research Day 2017
Poster Views: 67
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Poster Abstract
Introduction: Non-small cell lung cancer (NSCLC) is staged using Tumor-Node-Metastasis (TNM) status and the gold standard for treatment is still surgical lobectomy resection. Tumor pathologic histology is graded based on being well differentiated (Grade1), moderately differentiated (Grade2), or poorly differentiated (Grade3). We investigated effects of histologic grade on survival of patients (pts) with Stage-I neuroendocrine tumors after surgical resection.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified pts who underwent lobectomy for stage-I (T1N0M0 or T2N0M0) neuroendocrine carcinoma during 1988-2013, but excluded those who had multiple primary NSCLC tumors, had received radiation therapy, or had undifferentiated/anaplastic (Grade4) tumors. We grouped pts by histologic grade and performed Kaplan-Meier survival analyses, with log-rank test to compare 5-yr cancer-specific survival between grades, between T status, and between 1988-2003 versus 2004-2013. We identified possible covariates from univariate analysis (Chi-square, Fisher’s exact test, ANOVA, and student t-test) and significant imbalances from univariate (ie p<0.05 from univariate) was used as a variable in the Cox regression model to investigate possible predictors of survival by tumor Grade.

Results: Of 515 study pts, 348 were T1N0 pts, of whom 200 were Grade1, 52 were Grade2, and 96 were Grade3, and 167 were T2N0 pts, of whom 53 were Grade1, 31 were Grade2, and 83 were Grade3. During 1988-2013, T1N0 Grade3 pts had worse 5-yr survival than either T1N0 Grade2 or Grade1 pts (52.6% vs. 82.8% or 97.6%; p<0.001) and worse mean survival time (MST) than either T1N0 Grade2 or Grade1 pts (42.8 mon vs. 56.2 mon or 59.4 mon, p<0.05). In contrast, both T2N0 Grade3 and Grade2 pts had worse 5-yr survival than T2N0 Grade1 pts (54.0% or 68.4% vs. 93.6%; p=0.001) and MST (41.2 mon or 47.9 mon vs. 56.8 mon, p<0.05). For all Grade2 pts during 1988-2013, T2N0 pts had worse 5-yr survival than T1N0 pts (68.4% vs. 82.8%; p=0.07 by Log Rank Mantel-Cox, but p=0.038 by Breslow-Wilcoxon and p=0.047 by Tarone-Ware) and worse MST than T1N0 pts (47.9 mon vs. 56.2 mon, p<0.05). In contrast, for all Grade3 pts, T1N0 and T2N0 pts had similar 5-yr survival (52.6% vs 54.0%; p>0.53) and MST (41.2 mon vs. 42.8 mon, p>0.05) during 1988-2013. Neither Grade2 T1N0 or T2N0 nor Grade3 T1N0 or T2N0 had 5-yr survival or MST that significantly changed between 1988-2003 versus 2004-2013 (p>0.05). In T1N0 patients, the rate of death for Grade 1 and Grade 2 patients was only 2.8% and 22.9% of the rate of death for Grade 3, respectively. In T2N0 patients, the rate of death for Grade 1 was only 27.2% of the rate of death for Grade 3. In the T2N0 group, tumor location was found to be an independent risk factor affecting survival by Grade.


Conclusion: Using SEER data, we found Grade 3 NE patients had significantly worst survival than Grade 1 & 2 in both T1N0 & T2N0 patient populations. In T1N0 patients, the rate of death for Grade 1 and Grade 2 patients was only 2.8% and 22.9% of the rate of death for Grade 3, respectively. In T2N0 patients, the rate of death for Grade 1 was only 27.2% of the rate of death for Grade 3. In the T2N0 group, tumor location was found to be an independent risk factor affecting survival by Grade, a new finding past studies did not find. However, female gender, lymph node dissection, African-American ethnicity, and tumor size were not found to significantly impact survival, unlike past studies.3,4 These results suggest that histologic grade should be considered when determining adjuvant therapy and prognosis for surgically resected Stage-1 neuroendocrine carcinoma patients

Steuer CE, Behera M, Kim S, Chen Z, Saba NF, Pillai RN, et al. Atypical Carcinoid Tumor of the Lung: A Surveillance, Epidemiology, and End Results Database Analysis. J Thorac Oncol. 2015 Mar 1;10(3):479–85.

Iyoda A, Makino T, Koezuka S, Otsuka H, Hata Y. Treatment options for patients with large cell neuroendocrine carcinoma of the lung. Gen Thorac Cardiovasc Surg. 2014;62(6):351–6.

Fox M, Van Berkel V, Bousamra II M, Sloan S, Martin II RCG. Surgical management of pulmonary carcinoid tumors: sublobar resection versus lobectomy. Am J Surg. 2013 Feb;205(2):200–8.

Yendamuri S, Gold D, Jayaprakash V, Dexter E, Nwogu C, Demmy T. Is Sublobar Resection Sufficient for Carcinoid Tumors? Ann Thorac Surg. 2011 Nov 1;92(5):1774–9.
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