The continued importance of surgical resection in the management of pulmonary neuroendocrine tumours

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Background: Neuroendocrine tumours (NETs) represent a heterogeneous group of neoplasms arising from neuroendocrine cells, which are diffusely distributed throughout the body. The lungs and gastrointestinal tract are the most frequent primary sites. This study aimed to evaluate 5-year overall survival (OS) rates across various subtypes of pulmonary NETs (PNETs) following anatomical resection. Furthermore, it sought to identify potential prognostic factors influencing survival outcomes. Methods: A retrospective analysis was performed on patients diagnosed with PNETs who underwent anatomical resection at our institution between 2008 and 2023. Tumour staging was conducted in accordance with the 8th edition of the International Association for the Study of Lung Cancer (IASLC) classification. Survival outcomes were estimated using the Kaplan-Meier method, and prognostic factors were analysed via Cox regression analysis. Results: Between 2008 and 2023, a total of 3,345 patients underwent anatomical resections for lung cancer, of whom 145 were diagnosed with NETs. The overall 5-year survival rate for this cohort was 77%. Subgroup analysis revealed survival rates of 87% for typical carcinoid (TC) tumours, 83% for atypical carcinoid (AC), and 86% for large cell neuroendocrine carcinoma (LCNEC). In contrast, the 5-year survival rate for patients with small cell lung carcinoma (SCLC) was 59%. Conclusions: Surgical resection remains an effective therapeutic strategy for all histological subtypes of PNETs. Our 5-year survival analysis indicates that tumour histology, postoperative tumour category (T category), and N2 nodal status are the most significant prognostic factors influencing survival.

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