F-083PROGNOSTIC FACTORS IN A MULTICENTRE STUDY OF 246 ATYPICAL PULMONARY CARCINOIDS

Objectives To analyze clinical and biomolecular prognostic factors associated with the surgical approach and outcome of 246 atypical lung carcinoids (AC) in a multi-institutional experience. Methods We retrospectively evaluated clinical data and pathological tissue sample collected from 246 patients of ten Thoracic Surgery Units from different geographical areas of our country. All patients were divided in four groups according to the surgical procedure: sublobar resections (Group I), lobar resections (Group II), tracheobronchoplastic procedures (Group III), and pneumonectomies (Group IV). Overall survival analysis was performed using the Kaplan- Meier method and log-rank test. Survival was calculated from the date of the surgery to the last date of follow-up or death. The parameters evaluated included age, gender, smoking habits, laterality, type of surgery, 7th edition of TNM staging, mitosis, Ki67/MIB-1, multifocal forms, tumourlets and type of lymphadenectomy. For multivariate analysis, a Cox regression model was used with a forward stepwise selection of covariates. Results 246 patients (123 male, 123 female; median 60.5 years, range 10-84) underwent surgical resection for AC in the last thirty years as follows: n = 39 patients in Group I, n = 153 patients in Group II, 38 patients in Group III and 16 patients in Group IV. Smoking history was present in 134/246 patients (54.5%). Mean follow-up period was 61.5 months (range 2.8-366.8). Surgical approaches, mitosis (≤5 or >5) and Ki-67/MIB-1 are showed on graph. There were no significant differences between gender, tumour location, and type of surgery at the multivariate analysis. Age (P = 0.003), smoking habits (P = 0.007), pathological stage (P = 0.013) and mitotic index (P = 0.004) were all significant at multivariate analysis. Conclusions Atypical lung carcinoids are malignant neuroendocrine tumours with a worst outcome in patients over 60 years and in smokers. With exception of pneumonectomy, extent of resection does not seem to affect survival. Pathological staging along with mitotic index, more than Ki67/ MIB-1, appears to be the most significant prognostic factors. Disclosure All authors have declared no conflicts of interest.