Improvement of Lung NET Management through Standardized Care—A Swiss Nationwide Observational Study

SIMPLE SUMMARY: Patients with low- and intermediate-grade neuroendocrine tumors (NETs) of the lung, also called typical (TC) and atypical carcinoids (AC), are often managed in a very heterogenous way. This lack of standardized procedures, probably due to the rare occurrence of these tumors, was and is unfavorable for the affected patients. In 2015, the European NET society (ENETS) published new guidelines for best practice for TC and AC. Using data from the SwissNET registry, we wanted to check whether there was an impact of these guidelines on the diagnosis and treatment of the affected patients. As we could see, there was an improvement after 2016, in the sense of an increase in functional imaging and the determination of histopathological markers. Additionally, more systemic lymph node resections were conducted. These findings are encouraging; nevertheless there is room for further improvement in the management of these patients. ABSTRACT: Typical (TC) and atypical carcinoids (AC) are the most common neuroendocrine tumors (NETs) of the lung. Because these tumors are rare, their management varies widely among Swiss centers. Our aim was to compare the management of Swiss patients before and after the publication of the expert consensus of the European Neuroendocrine Tumor Society (ENETS) in 2015. We used data from the Swiss NET registry from 2009 to 2021 with patients with TC and AC. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Overall, 238 patients were included, 76% (180) thereof with TC and 24% (58) with AC, including 155 patients before and 83 patients after 2016. An increase in the use of functional imaging was observed, 16% (25) before and 35% (29) after 2016, p < 0.001. The presence of SST(2A)-receptors was determined more often: 32% (49 times) before 2016 and 47% (39 times) after, p = 0.019. Concerning therapy, higher removal of lymph nodes after 2016 was observed, 54% (83) before versus 78% (65) after, p < 0.001. Median overall survival for patients with AC was significantly shorter, with 89 months compared to 157 months for patients with TC, p < 0.001. While the implementation of a more standardized approach was observed over the years, there is still room for amelioration in the management of TC and AC in Switzerland.