Prognostic significance of laterality in lung neuroendocrine tumors

Anna La Salvia, Irene Persano, Alessandra Siciliani, Monica Verrico, Massimiliano Bassi, Roberta Modica, Alessandro Audisio, Isabella Zanata, Beatrice Trabalza Marinucci, Elena Trevisi, Giulia Puliani, Maria Rinzivillo, Elena Parlagreco, Roberto Baldelli, Tiziana Feola, Franz Sesti, Paola Razzore, Rossella Mazzilli, Massimiliano Mancini, Francesco PanzutoMarco Volante, Elisa Giannetta, Carmen Romero, Marialuisa Appetecchia, Andrea Isidori, Federico Venuta, Maria Rosaria Ambrosio, Maria Chiara Zatelli, Mohsen Ibrahim, Annamaria Colao, Maria Pia Brizzi, Rocío García-Carbonero, Antongiulio Faggiano

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose:: Well-differentiated lung neuroendocrine tumors (Lu-NET) are classified as typical (TC) and atypical (AC) carcinoids, based on mitotic counts and necrosis. However, prognostic factors, other than tumor node metastasis (TNM) stage and the histopathological diagnosis, are still lacking. The current study is aimed to identify potential prognostic factors to better stratify lung NET, thus, improving patients’ treatment strategy and follow-up. Methods:: A multicentric retrospective study, including 300 Lung NET, all surgically removed, from Italian and Spanish Institutions. Results:: Median age 61 years (13–86), 37.7% were males, 25.0% were AC, 42.0% were located in the lung left parenchyma, 80.3% presented a TNM stage I-II. Mitotic count was ≥2 per 10 high-power field (HPF) in 24.7%, necrosis in 13.0%. Median overall survival (OS) was 46.1 months (0.6–323), median progression-free survival (PFS) was 36.0 months (0.3–323). Female sex correlated with a more indolent disease (T1; N0; lower Ki67; lower mitotic count and the absence of necrosis). Left-sided primary tumors were associated with higher mitotic count and necrosis. At Cox-multivariate regression model, age, left-sided tumors, nodal (N) positive status and the diagnosis of AC resulted independent negative prognostic factors for PFS and OS. Conclusions:: This study highlights that laterality is an independent prognostic factors in Lu-NETs, with left tumors being less frequent but showing a worse prognosis than right ones. A wider spectrum of clinical and pathological prognostic factors, including TNM stage, age and laterality is suggested. These parameters could help clinicians to personalize the management of Lu-NET.

Original languageEnglish
Pages (from-to)733-746
Number of pages14
JournalEndocrine
Volume76
Issue number3
DOIs
StatePublished - Jun 2022

Keywords

  • Ki67 index
  • Lung neuroendocrine tumors
  • Mitotic count
  • Necrosis
  • Prognostic factors
  • Tumor location

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