Bronchial carcinoids: long-term prognostic factors.

Between 1962 and 1987 bronchial carcinoids were diagnosed in 41 patients (21 men, 20 women) at l'Hôpital du Sacré-Coeur and the Centre hospitalier Maisonneuve-Rosemont. The patients ranged in age from 19 to 73 years (mean 47 years). Fourteen of the 19 asymptomatic carcinoids were discovered on routine chest radiography. Twenty-two symptomatic patients presented with either pneumonia or hemoptysis. Tumours involved the right and left lungs equally. Thirty tumours were located centrally and 11 peripherally. Sensitivity of endoscopic biopsy specimens was 66%. No complications occurred during biopsy. Cytologic examination of sputum, lavage, brushing and transthoracic biopsy specimens was of no value in establishing the diagnosis. Thirty-seven patients underwent surgical resection: lobectomies (26, 3 with bronchoplasties), pneumonectomies (7), segmentectomies (2) and wedge resections (2). One patient (3%) died, and there was one major complication (3%) related to surgery. The mean follow-up was 8 years. The probability of survival was 97% +/- 3 at 5 years and 92% +/- 6 at 10 years. None of the 19 patients treated for a peripheral tumour died, but two patients who had centrally located tumours that exhibited transbronchial invasion and lymph-node metastasis died. No prognostic information could be gained from tumour size or type. A statistical association was found between transbronchial invasion and lymph-node metastasis. Bronchial carcinoids are low-grade malignant tumours. Resection should be conservative, but lymph-node involvement requires a more radical approach.