Proposal of organ-specific subdivision of M component and staging system for metastatic pulmonary neuroendocrine tumor. (October 2020)

• Record Type: Journal Article
• Authors: Wen, Junmiao; Chen, Jiayan; Liu, Di; Chen, Donglai; Chen, Yongbing; Fan, Min; Lu, Bo
• Is Part Of: Lung cancer. Volume 148(2020)
• Page Start: 86
• Page End: 93
• Publication Date: 2020-10
• Subjects: NETs neuroendocrine tumors -- PNETs pulmonary neuroendocrine tumors -- TC typical carcinoid -- LCNC large-cell neuroendocrine carcinoma -- AJCC the American Joint Committee on Cancer -- TNM tumor-node-metastases -- NSCLC non-small cell lung cancer -- GEP gastro-entero-pancreatic -- GI gastrointestinal -- SEER the Surveillance, Epidemiology and End Results Program -- PORT postoperative radiotherapy -- CSS cancer-specific survival -- HR hazard ratios -- CI confidence interval; Pulmonary neuroendocrine tumors -- Metastatic disease -- Prognosis -- Staging system; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.08.003
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Subdivision of M1 component according to patterns of distant metastatic sites facilitates prognostic significance for stage IV pulmonary neuroendocrine tumors. Brain metastases and multiple metastatic sites were associated with significantly inferior prognosis. Surgical resection to the primary sites should be considered to improve outcomes. Incorporating histological type and novel M component create a unique staging system for pulmonary neuroendocrine tumors with distant metastatic. Abstract: Objectives: To evaluate the prognostic significance of patterns of distant metastatic organs in metastatic pulmonary neuroendocrine tumors (PNETs). Methods: 891 metastatic PNETs patients (G1-typical carcinoid, 200; G2-atypical carcinoid, 68; G3-large-cell neuroendocrine carcinoma, 623) diagnosed between 2010 and 2016 were identified. Multivariate analysis was performed using a Cox regression model to identify prognostic factors associated with cancer-specific survival (CSS). The novel M component was established based on the hazard ratio of different metastatic organs. A disease-specific staging system was then proposed by using k-means cluster analysis. Results: For metastatic PNETs, involvement of bone, liver or brain and multiple metastatic organs were identified as independent prognostic factors in multivariate analysis. M categories was subdivided into three subcategories: M1a, lung involvement only or distant lymph node involvement only; M1b, bone involvement only or liver involvement only; M1c, brain involvement regardless of number of metastatic organs or multiple organs involvement except brain. Primary site surgery, chemotherapy and histologic subtypes were independently associated with CSS, but T component and N component were not. After regrouping histologic subtypes and novel M component, we proposed the following modified staging system: stage IVA (G1M1any, G2M1a-b), stage IVB (G2M1c, G3M1a-b) and stage IVC (G3M1c). The 2-year CSS were 77.9 %, 16.4 % and 5.3 %. Conclusions: Subdivision of M component according to patterns of distant metastatic organs facilitates prognostic significance for PNETs. Brain metastases and multiple metastatic organs were associated with significantly inferior prognosis. Incorporating histologic subtypes and novel M categories create a disease-specific staging system showed good discriminatory capacity.