Modified staging system for pulmonary carcinoids on the basis of lung cancer TNM system
- 136 Downloads
Pulmonary carcinoids are being staged along the lines of lung cancer American Joint Committee on Cancer (AJCC) staging system. The current study evaluated the prognostic value of a modified staging system for patients with pulmonary carcinoid.
Patients and methods
Surveillance, Epidemiology and End Results (SEER) database (2004–2014) was searched through SEER*Stat program. Through recursive partitioning analysis and subsequent decision tree formation, suggested stages were constructed. Overall survival analyses were performed through Kaplan–Meier analysis. The cancer-specific Cox regression hazard (adjusted for age, gender, race, sub-site and surgery) was calculated and pairwise comparisons of hazard ratios were conducted.
A total of 6395 pulmonary carcinoid patients were recruited in the period from 2004–2014. Pairwise hazard ratio comparisons among different AJCC 8th stages were conducted and all comparisons were non-significant except for stage IIB vs. stage IIIA and stage IIIA vs. stage IIIB. Pairwise hazard ratio comparisons among different modified staging system stages were conducted and all comparisons were significant except for stage III vs. stage IV. C-statistic (using death from pulmonary carcinoid as the dependent variable) for AJCC 8th staging system was: 0.794 (SE 0.013; 95% CI 0.769–0.818); for AJCC 7th staging system was: 0.789 (SE 0.013; 95% CI 0.764–0.815), while c-statistic for the modified staging system was: 0.802 (SE 0.012; 95% CI 0.778–0.827).
The proposed modified staging system provided a simpler yet prognostically more relevant classification of pulmonary carcinoids compared to AJCC staging systems (both 7th and 8th editions).
KeywordsStaging NET Carcinoid Prognosis
Compliance with ethical standards
This study was not funded.
Conflict of interest
The author declares that he has no conflict of interest.
This article does not contain any studies with human participants or animals performed by the author.
As this study is based on a publicly available database without identifying patient information, informed consent was not needed.
- 5.Travis WD, Giroux DJ, Chansky K, Crowley J, Asamura H, Brambilla E, et al. The IASLC Lung Cancer Staging Project: proposals for the inclusion of broncho-pulmonary carcinoid tumors in the forthcoming (seventh) edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2008;3(11):1213–23.CrossRefPubMedGoogle Scholar
- 9.Lococo F, Stefani A, Treglia G. Is fludeoxyglucose-fluorodeoxyglucose-positron emission tomography/computed tomography ((18)F-FDG-PET/CT) really useless in staging pulmonary carcinoid tumors and in discriminating histological subtypes? Controversial points and future perspectives. Ann Thorac Med. 2015;10(3):217–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Eberhardt WE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A 3rd, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2015;10(11):1515–22.CrossRefPubMedGoogle Scholar
- 12.Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 18 Regs Custom Data (with additional treatment fields), Nov 2016 Sub (1973–2014 varying)—Linked To County Attributes—Total US, 1969–2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2017, based on the November 2016 submission. https://seer.cancer.gov/