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B.I. Hiddinga



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    P3.16 - Poster Session 3 - Other Thoracic Malignancies (ID 188)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P3.16-002 - Outcome and prognostic factors of bronchopulmonary neuroendocrine tumors (BNETS): a single intitutional series (ID 2277)

      09:30 - 09:30  |  Author(s): B.I. Hiddinga

      • Abstract

      Background
      BACKGROUND: BNETs consist of typical carcinoids (TC), atypical carcinoids (AC) and large cell neuroendocrine carcinomas (LCNEC) based on cellular differentiation, mitotic count and the presence or absence of necrosis [Travis 2004]. Since 2009, NETs are included in the TNM-classification for lung cancer [Sobin 2009]. Whilst increasing evidence points towards the prognostic value of the Ki67 index (a measure of the proliferative capacity [Rugge 2008, Grimaldi 2011]), it is unclear which classification method provides the best prognostic stratification. In this series, the prognostic value of clinicopathological characteristics was assessed, including differentiation, stage and proliferation.

      Methods
      METHODS: Medical records of pts with a histologically proven BNET, treated at Ghent University Hospital between January 2001 and June 2012, were retrospectively reviewed for clinical, staging, histopathological and treatment data. Overall and disease-specific survival (DSS) were estimated and correlated to clinicopathological features using uni- and multivariate analysis.

      Results
      RESULTS: Information on differentiation and staging was available in 55 of 57 retrieved pts (96.5%). Tumors were mostly TC (49%) or LCNEC (42%). Twelve pts (22%) presented with stage IV disease, 7 (13%) stage III, 9 (16%) stage II and 27 (49%) stage I. The Ki67 index was assessed in 14 tumors (25%), with a median of 12.5% (2.0 – 95.0%). Ki 67 levels were lowest in TCs and highest in LCNECs (p = 0.014). Forty-one (72%) patients underwent a resection, which was R0/1 in 39. Outcome data are in the table. A strong association was found between differentiation and stage (p <0.001). With a median follow-up of 25 months (0.0 – 132.0), 17 pts (29.8%) died from a tumor-related cause. Male gender (p = 0.025), peripheral tumor (p = 0.04), LCNEC (p < 0.001), higher Ki 67 index (p= 0.03) and stage IV (p < 0.001) were significant predictors of lower DSS in univariate analysis. Ki 67 index was not included in the multivariate analysis, which identified tumor stage as the independent predictor of DSS. Pts with stage IV disease had a 27-fold (95% CI 2.7 – 263.4, p = 0.005), those with stage III disease a 12-fold (1.3 – 113.1, p = 0.026) increased risk of dying from their BNET compared to pts with stage II disease. None of the 27 pts with stage I disease died from a tumor-related cause.

      Median (m) 1y SR (%) 3y SR (%) 5y SR (%) 10y SR (%)
      Disease-specific survival 128 81.5 67.3 67.3 67.3
      Overall survival 128 76.6 63.2 63.2 63.2

      Conclusion
      CONCLUSION: In this series of BNETS, tumor stage is the only independent predictor of prognosis. Further research is needed to assess the prognostic value of Ki67.