Wedge Resection Versus Anatomic Resection For Long-Term Survival Outcomes Of Stage Ia Pulmonary Atypical Carcinoids: A Seer Population-Based Study

Background: This study aims to compare the long-term survival of patients with stage IA atypical carcinoids (ACs) who underwent wedge resection versus those who underwent anatomic resection. Methods: Patients with pathological stage IA AC from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2004 and 2015 were included. Cox regression analyses were used to assess the association of overall survival (OS) and type of surgery. Subgroup analyses were conducted to further validate the robustness of our findings. Results: Among the 299 eligible patients, 168 (73.4%) patients underwent anatomic resection, and 61 (26.6%) patients underwent wedge resection. A multivariate Cox analysis demonstrated that age at diagnosis (HR: 5.935, P < 0.001) and surgical resection (HR: 0.409, P = 0.004) were independent prognostic factors for predicting long-term OS. In the subgroup analysis, the patients who had anatomic resections were significantly associated with better clinical outcomes than those who underwent wedge resections when the tumor size was between 20 mm and 30 mm (HR: 0.178, P = 0.006). We also found that anatomic resection tended to have a benefit for the prognosis among tumors ranging from 10 mm to 20 mm, but without statistical significance (P = 0.058). There was no significant difference when tumor size <= 10 mm (P = 0.006). Conclusions: Anatomic resection showed superior long-term survival compared with wedge resection in patients with stage IA ACs and with a tumor size between 10 mm and 30 mm. For patients with a tumor size <= 10 mm, wedge resection showed acceptable clinical outcomes.