Table 2.
Summary of the available studies examining the use of adjuvant therapy in the treatment of stage I, II, and III typical carcinoid and atypical carcinoid
| Study information; Stage and Subgroup |
Ref.
|
|||||||
|
Westin et al[23], 2017
|
Wegner et al[21], 2019
|
Gosain et al[22], 2019
|
Nussbaum et al[24], 2015
|
Anderson et al[25], 2017
|
Herde et al[26], 2018
|
Chong et al[27], 2014
|
Buonerba et al[29], 2010
|
|
| AT | Chemotherapy | Chemotherapy, radiation or chemoradiation | Chemotherapy | Chemotherapy | Chemotherapy | Chemoradiation or radiation alone | Chemoradiation | Chemotherapy; SSA |
| Study | Retrospective; NCDB | Retrospective; NCDB | Retrospective; NCDB | Retrospective; NCDB | Retrospective; NCDB | Retrospective; Single Institution | Retrospective; Single Institution | Case Report |
| Subgroup | TC/AC | TC/AC | TC/AC | TC | AC | TC/AC | TC/AC | AC |
| Stage | IIB,III | I,II,III | I,II,III | IIB,III | I,II,III | I,II,III | IIB,IIIA | I |
| Other | node + | NA | NA | node + | Comparing node + and node - | NA | NA | NA |
| I; TC | NA | Surgery without AT3 | Surgery without AT | NA | NA | AT in patients with adverse pathologic features9 | NA | NA |
| I; AC | NA | Surgery without AT3 | Surgery without AT@ (5-yr OS of 84% in obs vs 52% AT; P < 0.01) | NA | Surgery without AT in node - (OS at 12 and 60 mo in AT 86.7% and 73.3%, vs obs 87.9% and 72.3% P = 0.54). | AT in patients with adverse pathologic features9 | NA | Chemotherapy followed by SSA; 10-yr PFS |
| II; TC | Surgery without AT (inferior OS with AT)1 | Surgery without AT3 | Surgery without AT | Surgery without AT5,6 (5-yr OS 81.9% obs, vs 69.7% AT; P = 0.042) | NA | AT in patients with adverse pathologic features9 | chemotherapy may be beneficial in a subset of patients8 | NA |
| II; AC | Surgery without AT (no OS benefit)2 | Surgery without AT3 | Surgery without AT (5-yr survival of 81% in obs vs 55% AT; P = 0.34). | NA | Surgery without AT in node +7 | AT in patients with adverse pathologic features9 | chemotherapy may be beneficial in a subset of patients8 | NA |
| III; TC | Surgery without AT (inferior OS with AT)1 | Surgery without AT4 | Surgery without AT | Surgery without AT5,6 (5-yr OS 81.9% obs, vs 69.7% AT; P = 0.042) | NA | AT in patients with adverse pathologic features9 | chemotherapy may be beneficial in a subset of patients8 | NA |
| III; AC | Surgery without AT (no OS benefit)2 | Surgery without AT4 | Surgery without AT but trend towards benefit (46% in obs vs 54% AT; P = 0.24) | NA | Surgery without AT in node +7 | AT in patients with adverse pathologic features9 | chemotherapy may be beneficial in a subset of patients8 | NA |
Stage IIB, III grouped together and was associated with inferior OS (HR: 3.8; 95%CI: 1.9-7.0; P = 0.004).
Stage IIB, III grouped together with no befit in OS (HR: 1.1; 95%CI: 0.68-1.78; P = 0.6).
TC and AC stage I and II tumors grouped together to show a median survival of 114 months versus 117 months with observation (P = 0.30).
TC and AC stage III tumors favored observation with a median survival of 79 mo vs 63 mo (P = 0.89).
Adjuvant treatment showed a harmful effect.
When baseline patient features were matched a statistical difference in OS no longer existed but there was a towards detriment (69.7% vs 80.9%; P = 0.096).
Node + stage II and III grouped together; OS at 12 and 60 mo in AT 98.9% and 47.9%, vs obs 98.4% and 67.1%; P = 0.46.
Stage IIB and IIIA grouped together; at 2-yr follow up, there was a 28% recurrence rate for those with local regional disease.
Stage I, II, III AC and TC grouped together; overall AT showed a 20% recurrence rate.
AT: Adjuvant therapy; AC: Atypical carcinoid; Obs: Observation; OS: Overall survival; NA: Not applicable; NCDB: National cancer database; PFS: Progression free survival; SSA: Somatostatin analogue; TC: Typical carcinoid.