Typical bronchial carcinoids are usually considered fairly benign tumors. M
etastases do however occur, and up to 10% of the patients ultimately die fr
om their disease. To identify prognostic markers, we immunostained 43 typic
al bronchial carcinoids with antibodies against 8 possibly relevant hormone
s, oncogenes, tumor suppressor genes, adhesion molecules, and proliferation
markers. Altogether 12 patients (28%) had metastatic disease, of whom 10 h
ad regional lymph node metastases at diagnosis. Distant metastases have occ
urred in 5 patients (12%); all of these have died from their disease. Patie
nts with high expression of Ki-67 had shorter survival time (P < 0.01). Non
e of the immunostained hormones correlated to distant metastases or shorter
survival time, but gastrin-releasing peptide correlated to metastatic dise
ase (P < 0.05). All patients who died had CD44-negative tumors (P < 0.001).
Nuclear nm23 staining correlated to decreased risk for metastatic disease
and distant metastases per se (P < 0.01). Bcl-2 and p53 were associated wit
h increased risk for distant metastases (P < 0.05 and P < 0.01, respectivel
y). We conclude that some patients with typical bronchial carcinoids die fr
om their disease and that gastrin-releasing peptide, Bcl-2, and p53 may be
of importance for the malignant transformation of the tumor. Moreover, CD44
, nm23, and Ki-67 may give valuable prognostic information and help identif
y the patients at risk of disease-related death.