Introduction: Surgery is the only known curative therapy for lung/bronchial neuroendocrine tumours (NET). Factors that affect survival after surgery for lung NET are not clear, and hence follow up protocols are not evidence-based.
Methods: We collected data on 318 prospective patients that were operated on at a single centre between 2012 and 2020 (Guys and St Thomass regional thoracic surgery unit). The aim was to generate the overall survival of the cohort, and factors affecting survival. Factors that were entered into the survival analyses included sex, age, operation type, location of tumour (right vs. left lung), type of carcinoid (typical vs. atypical), presence of tumour necrosis, mitotic index, size of tumour, margin, and the TNM stage. Overall survival was calculated from NHS Spine and date of last follow up was 1st August 2023. Statistical analysis was performed using RStudio. Kaplan Meier curves for survival and for different subgroups were generated. Log rank tests for subgroups were performed. Univariate and multivariate analyses were performed using Cox regression.
Results: Females were 70% of the cohort. Median age was 63 years [18-89]. Tumours were 80% typical and 17% atypical carcinoids. 75% of patients had T1 stage. Operations included 263 lobectomies, 6 pneumonectomies and 32 wedge resections. Thirty-day survival was 99.4% [99-100%]. 1-year, 3-year and 5-year survival were 99%, 97% and 94% respectively. Factors that were significant on the univariate analysis were age, presence of necrosis, mitotic index, tumour size, and wedge resection. Factors that were significant on the multivariate analysis were age, mitotic index. Both analyses are summarized in the attached table.
|Presence of necrosis||3.46*||0.71|
|*P < 0.05|
Conclusion: This is one of the largest single centre series with complete follow up in terms of survival. Five-year survival at 94% indicates surgery is the rational initial therapy even in node positive cases, but caution is needed in those with higher mitotic index. Good patient selection and high volume regional centres can result in good outlook for these relatively rare tumours.*