P-128BRONCHIAL CARCINOID TUMOURS WITH NODAL INVOLVEMENT

To determine nodal involvement (Nlv) in lung carcinoids and its implication in prognosis. From 1998 to 2009, a multicentre study group collected 923 cases of lung carcinoid tumours in 2 groups: Retrospective (until 1997): 345 (88.5%) typical carcinoids (TC) and 45 (11.5%) atypical carcinoids (AC); Prospective: 451 (84.6%) TC and 82 (15.4%) AC. All the pathological cases were classified according to 2004 WHO-classification and 7th TNM edition. Mediastinal sampling or nodal mediastinal dissection were systematically performed in the prospective group. Clinical variables considered were age, location (central, peripheral), nodal involvement and pTNM stage. Survival data and incidence of metastases were determined. Statistical analysis was made using SPSS (Statistical Package Social Sciences 19.0). Student's t and Pearson's chi-squared test were performed. Survival analysis: Kaplan-Meier, Mantel-Cox log-rank test. Multivariate analysis: Cox regression. Significancy P < 0.05. Surgical procedures (SP) performed in TC/AC were standard resection 75%/83%, bronchoplastic resection 11%/5% and sublobar resection 14%/12%, respectively. The data as regards to distribution of nodal involvement by histology, location and restrospective vs prospective group and survival at 5 and 10 years are summarized as follows. TC vs AC pN + , P = 0.001. Metastases at follow-up stage: TC 22 (16 N0, 5 N1, 1 N2) P = 0.001; AC 27 (14 N0, 5 N1, 8 N2) P = 0.077. Multivariate analysis: TC: Survival: the most significant risk factors were: age HR 1.063 (P = 0.000), M factor HR 7.85 (P = 0.002) and metastases at follow-up stage HR 6.174 (P = 0.000). Nodal involvement and SP were not significant. Metastases: nodal involvement HR 5.809 (P = 0.001) and retrospective group HR 2.788 (P = 0.027). AC: Survival: retrospective group HR 5.12 (P = 0.002), nodal involvement HR 2.14 (P = 0.027) metastases at follow up stage HR 6.67 (P = 0.000). Metastases: age HR 1.05 (0.015), nodal involvement HR 2.855 (P = 0.035) and retrospective group HR 1.714 (P = 0.258). Survival is not influenced by nodal involvement in TC but shows a clear influence in AC. Standard lymphadenectomy improved survival in the prospective group. Systematic lymphadenectomy should be always performed in both typical and atypical carcinoid. All authors have declared no conflicts of interest.