The age-adjusted rates and treatment of typical carcinoid tumors of the lung.

e20507 Background: Pulmonary typical carcinoid tumors(TC) are rare and the treatment of these tumors has not been well studied. The purpose of our investigation is to find whether or not these tumors are increasing in frequency and to assess the value of different treatment options. Methods: The National Cancer Database was queried from the years 2004-2015 for those patients who underwent a surgical resection((bi)lobectomy(L+) or sub-lobar resection(L-)) of TC. Multi-variate analysis for overall survival (OS) in surgical patients was used for propensity matching to determine the benefits of (L-) vs (L+) and to assess the role of chemotherapy or radiation in node positive disease(N+). SEER-18 was used to estimate the age-adjusted rates of TC and the percentage of N+ tumors during the years of our study. Results: With a median follow-up of 62.1 months, 16337 patients underwent surgical resection of TC of which 7846, 7538, 644, 302, and 7 patients had NX, N1, N2, and N3 disease. The rate of TC per 100,000 population progressively and significantly increased from 3.2 to 5.4 while the rate of node positivity remained flat at 0.3-0.4/100,000 population. Adjuvant therapy was given to 155 patients with radiation and 945 with chemotherapy. In the total population, a significant OS benefit was noted in those undergoing a L+ compared to L- (HR = 1.35 p < 0.0001), which was not seen in patients with node negative tumors < 2cm, but was seen in node negative tumors > 2cm (HR = 2.00, p 0.0088) and N1(HR = 3.2, P < 0.0001) and N2 disease(HR = 4.2, p < 0.0001. N2(HR = 2.25, p < .0001 and N1 disease(HR = 1.53 p = 0.0021) had a significant lower OS than N0 disease which were not improved not with radiation therapy(p-value 0.4055) and worsened with both adjuvant chemotherapy(median OS HR p value = < 0.0001). Conclusions: Typical carcinoid tumors are increasing in the US population and should undergo a lobectomy when the size > 2cm or when node positive disease is present. Despite the worse prognosis of patients with node positive disease, radiation did not improve and chemotherapy worsened OS.