Prognostic significance of Pulmonary Multifocal Neuroendocri
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The study states that the connection with multifocal pulmonary neuroendocrine proliferation (MNEP) shows a clinically and prognostic relevant factor in Typical Carcinoid (TC).

The aim of the study was to find the clinical significance of multifocal pulmonary neuroendocrine proliferation (MNEP), including tumorlets and pulmonary neuroendocrine cell hyperplasia, in association with Typical Carcinoid (TC).

A retrospective series of TC with long-term follow-up data prospectively collected from two institutions was evaluated, and the outcome comparison between TC alone and MNEP+TC was investigated. Several baseline covariates were imbalanced between the MNEP+TC and TC groups, therefore, researchers have conducted 1:1 propensity score matching and inverse probability of treatment weighting (IPTW) in the full sample. In the matched group, the association of clinical, respiratory, and work-related factors with the group was determined through univariable and multivariable conditional logistic regression analysis.

234 TC patients have undergone surgery: 41 MNEP+TC and 193 TC alone. The result showed;

--In the MNEP+TC group older age, peripheral tumors, smaller tumor size, and lymph-nodal spread were observed in comparison with the TC group.

--Relapses occurred in 8 patients of the MNEP+TC group and in 7 of the TC group.

--After matching, in 36 pairs of patients a significantly higher 5-years progression-free rate was observed for the TC group. Similar results were observed using IPTW in the full sample.

--Odds of being in the MNEP+TC group were higher with work-related exposure to inhalant agents, asthma/bronchitis, emphysema, fibrosis, and inflammatory status, micronodules on the chest CT scan, and respiratory insufficiency.

In conclusion, the association with MNEP seems to represent a clinically and prognostic relevant factor in TC. Hence, careful pre-operative workup, systematic pathological evaluation, including non-tumorous lung parenchyma, and long-term postoperative follow-up should be recommended in these patients.

The Annals of Thoracic Surgery