The following is a summary of “Factors Associated With Long-term Survival in Children With Bronchial and Lung Carcinoid Tumors,” published in the February 2024 issue of Pediatrics by Raikot et al.

In pediatric oncology, bronchial carcinoids constitute a rare entity, posing unique challenges in treatment strategies primarily extrapolated from adult populations. This study explores the nuanced factors influencing long-term survival outcomes among pediatric patients afflicted with this condition, utilizing a comprehensive national cohort analysis. Through meticulous scrutiny of patients aged ≤ 20 years harboring bronchial carcinoid tumors, as identified within the expansive purview of the 2004-2020 National Cancer Database utilizing rigorous ICD-O-3 coding protocols, this investigation meticulously dissects tumor characteristics and therapeutic modalities, discriminating between the typical (TC) and atypical (AC) histological subtypes via robust statistical methodologies including Chi-square and Fisher’s exact tests. 

The findings, drawn from a cohort comprising 273 individuals, with 92% presenting with TCs and the remainder with ACs, underscore a median age of 18, indicative of the relatively youthful demographic afflicted by this condition. Predominant treatment modalities included lobectomy or bilobectomy, undertaken in 67% of cases, followed by sub lobar resection (17%), with a noteworthy proportion (8%) undergoing either no resection or bronchoscopic excision or ablation, alongside pneumonectomy (7.7%). Impressively, negative margins were achieved in 96% of cases, indicative of meticulous surgical management. Lymph node (LN) assessment, a critical determinant of disease staging and prognostication, was diligently executed in 84% of cases, yielding a median LN yield of 7, with 23% exhibiting ≥1 positive LN, underscoring the indispensable role of lymph node evaluation in prognostic stratification. Strikingly, the incidence of nodal metastasis failed to exhibit a discernible escalation beyond the resection of 1-3 LNs, thereby accentuating the nuanced interplay between surgical approach and disease dissemination. 

Long-term survival analysis revealed stark differentials between AC and TC cohorts, with a ten-year survival rate of 79% versus 98%, respectively, corroborating the ominous prognostic implications associated with atypical histology. Importantly, positive LN emerged as a harbinger of dismal outcomes, with a ten-year survival rate plummeting to 89% in affected individuals. In light of these findings, it becomes evident that meticulous attention to histological subtype and lymph node status is paramount in prognostic delineation and therapeutic stratification, underscoring the indispensable role of surgical intervention and lymph node sampling in optimizing survival outcomes among pediatric patients grappling with bronchial carcinoids.

Source: sciencedirect.com/science/article/abs/pii/S0022346824001064