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Abstract：
OBJECTIVE: The observation-based prognosis, rather than resection, for small carcinoid tumors is still unclear. This lack of clarity has important implications for counseling elderly patients or patients for whom surgical resection poses a high risk. This study compared the outcomes of observation and surgical resection in patients with pulmonary carcinoid (PC) tumors ≤3 cm in size without metastasis.
METHODS: Data of patients with PC tumors with ≤3 cm in diameter and without lymph node and distant metastases were retrieved from Surveillance, Epidemiology, and End Results (SEER) registry. To reduce the inherent bias of retrospective studies, propensity score matching analysis was performed. Overall survival (OS) and lung carcinoid-specific survival (LCSS) were analyzed using Kaplan-Meier plots. Multivariate analysis was used to determine predictors of LCSS in different size subgroups.
RESULTS: In total, 4552 patients with early-stage PCs ≤3 cm in diameter, including 435 (9.56%) who were observed and 4117 (90.44%) treated by surgery, were recruited. Patients with surgery had significantly better OS and LCSS than those who were observed. However, patients with observation had comparable LCSS to those with surgery for PCs with tumor diameters ≤1 cm. Multivariate analysis indicated that surgical resection was an independent prognostic factor for LCSS in 1 cm < tumors ≤2 cm, and 2 cm < tumors ≤3 cm groups, but not for tumors ≤1 cm in diameter.
CONCLUSIONS: Surgical resection of small PCs is associated with a survival advantage over observation. However, for early PCs ≤1 cm in diameter, observation may be considered in patients with high risk for surgical resection.
METHODS: Data of patients with PC tumors with ≤3 cm in diameter and without lymph node and distant metastases were retrieved from Surveillance, Epidemiology, and End Results (SEER) registry. To reduce the inherent bias of retrospective studies, propensity score matching analysis was performed. Overall survival (OS) and lung carcinoid-specific survival (LCSS) were analyzed using Kaplan-Meier plots. Multivariate analysis was used to determine predictors of LCSS in different size subgroups.
RESULTS: In total, 4552 patients with early-stage PCs ≤3 cm in diameter, including 435 (9.56%) who were observed and 4117 (90.44%) treated by surgery, were recruited. Patients with surgery had significantly better OS and LCSS than those who were observed. However, patients with observation had comparable LCSS to those with surgery for PCs with tumor diameters ≤1 cm. Multivariate analysis indicated that surgical resection was an independent prognostic factor for LCSS in 1 cm < tumors ≤2 cm, and 2 cm < tumors ≤3 cm groups, but not for tumors ≤1 cm in diameter.
CONCLUSIONS: Surgical resection of small PCs is associated with a survival advantage over observation. However, for early PCs ≤1 cm in diameter, observation may be considered in patients with high risk for surgical resection.
摘要：
目的：基于观察的预后，而不是切除，对于小类癌肿瘤仍不清楚。这种缺乏清晰度对于咨询老年患者或手术切除风险高的患者具有重要意义。这项研究比较了肺类癌（PC）肿瘤大小≤3cm且无转移的患者的观察结果和手术切除结果。
方法：从监测中检索直径≤3cm且无淋巴结和远处转移的PC肿瘤患者的数据，流行病学,和结束结果(SEER)注册表。为了减少回顾性研究的固有偏差，进行倾向评分匹配分析.使用Kaplan-Meier图分析总生存期(OS)和肺类癌特异性生存期(LCSS)。多变量分析用于确定不同大小亚组中LCSS的预测因子。
结果：总计，4552例早期PCs直径≤3cm,包括435例(9.56%)被观察到的患者和4117例(90.44%)接受手术治疗的患者，被招募。手术患者的OS和LCSS明显优于观察患者。然而,接受观察的患者的LCSS与接受肿瘤直径≤1cm的PC手术的患者相当.多因素分析显示手术切除是1cm<肿瘤≤2cm时LCSS的独立预后因素,和2cm<肿瘤≤3cm组，但不适用于直径≤1厘米的肿瘤。
结论：手术切除小PCs具有优于观察的生存优势。然而,对于直径≤1厘米的早期PCs，手术切除风险高的患者可考虑观察。
方法：从监测中检索直径≤3cm且无淋巴结和远处转移的PC肿瘤患者的数据，流行病学,和结束结果(SEER)注册表。为了减少回顾性研究的固有偏差，进行倾向评分匹配分析.使用Kaplan-Meier图分析总生存期(OS)和肺类癌特异性生存期(LCSS)。多变量分析用于确定不同大小亚组中LCSS的预测因子。
结果：总计，4552例早期PCs直径≤3cm,包括435例(9.56%)被观察到的患者和4117例(90.44%)接受手术治疗的患者，被招募。手术患者的OS和LCSS明显优于观察患者。然而,接受观察的患者的LCSS与接受肿瘤直径≤1cm的PC手术的患者相当.多因素分析显示手术切除是1cm<肿瘤≤2cm时LCSS的独立预后因素,和2cm<肿瘤≤3cm组，但不适用于直径≤1厘米的肿瘤。
结论：手术切除小PCs具有优于观察的生存优势。然而,对于直径≤1厘米的早期PCs，手术切除风险高的患者可考虑观察。
