Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Department of Pathology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Curr Probl Cancer. 2019 Feb;43(1):54-65. doi: 10.1016/j.currproblcancer.2018.05.006. Epub 2018 May 24.
Large cell neuroendocrine carcinoma (LCNEC) is a rare type of high-grade pulmonary neuroendocrine tumor. The study objective is to investigate its survival outcomes, incidence of brain metastases, and patterns of recurrence.
This is a single center study of patients with pathologic diagnosis of pulmonary LCNEC. Patient data were collected retrospectively and analyzed, including survival, incidence of brain metastases, and patterns of recurrence.
Of 87 patients (stages I: 24, II: 14, III: 23, IV: 26), 52 were managed curatively and 35 palliatively. The median follow-up time was 17.3 months (range 0.6-89.5) for those treated with curative intent and 7.0 months (range 0.1-28.6) for those treated palliatively. The 2- and 5-year overall survival (OS) rates are 48.4% and 25.5% for the curative group, with a median OS of 13.5 months. In the palliative group, the OS are 30.8% at 1 year and 6.8% at 2 years, with a median OS of 7.0 months. Thirty-eight of 52 (73%) patients treated with curative intent had disease relapse, with the common sites being regional lymph nodes (20), brain (18), bones (11), and liver (9). The incidence of brain recurrence among those managed curatively are 21.4% and 41.3%, respectively at 1 and 2 years. Of 18 patients experiencing brain metastases, 14 developed them as part of a first relapse.
LCNEC's survival outcomes are poor. The incidence of brain metastases is higher than what is observed for other types of nonsmall cell lung cancers. Prophylactic cranial irradiation should be investigated as a means of improving outcomes.
大细胞神经内分泌癌（LCNEC）是一种罕见的高级别肺神经内分泌肿瘤。本研究旨在探讨其生存结局、脑转移发生率和复发模式。
这是一项对经病理诊断为肺 LCNEC 的患者进行的单中心研究。回顾性收集患者数据并进行分析，包括生存情况、脑转移发生率和复发模式。
87 例患者（I 期 24 例、II 期 14 例、III 期 23 例、IV 期 26 例）中，52 例接受了根治性治疗，35 例接受了姑息性治疗。根治性治疗患者的中位随访时间为 17.3 个月（范围 0.6-89.5），姑息性治疗患者为 7.0 个月（范围 0.1-28.6）。根治性治疗组的 2 年和 5 年总生存率（OS）分别为 48.4%和 25.5%，中位 OS 为 13.5 个月。姑息性治疗组的 1 年 OS 为 30.8%，2 年 OS 为 6.8%，中位 OS 为 7.0 个月。52 例接受根治性治疗的患者中有 38 例（73%）出现疾病复发，常见部位为区域淋巴结（20 例）、脑（18 例）、骨骼（11 例）和肝脏（9 例）。根治性治疗患者中脑复发的发生率分别为 1 年时 21.4%和 2 年时 41.3%。18 例发生脑转移的患者中，14 例在首次复发时发生脑转移。
LCNEC 的生存结局较差。脑转移的发生率高于其他类型的非小细胞肺癌。应研究预防性颅脑照射作为改善结局的一种手段。
