a Division of Radiation Oncology , Allegheny Health Network Cancer Institute , Pittsburgh , PA , USA.
b Department of Neurosurgery , Allegheny Health Network Cancer Institute , Pittsburgh , PA , USA.
Acta Oncol. 2019 Apr;58(4):499-504. doi: 10.1080/0284186X.2018.1564841. Epub 2019 Feb 7.
Large cell neuroendocrine carcinoma (LCNEC) of the lung is a rare pulmonary tumor, having similar natural history and management strategy as small cell lung cancer. Therefore, the management of brain metastases in these patients has mirrored that of SCLC through the use of whole brain radiation therapy (WBRT). We used the National Cancer Database (NCDB) to look at predictors of stereotactic radiosurgery (SRS) and any potential differences in outcomes for patients with brain metastases from LCNEC.
We queried the NCDB from 2004 to 2015 for patients with LCNEC of the lung with brain metastases that received brain radiation. Univariable and multivariable analyses were performed to identify factors predictive of SRS use and overall survival (OS). Propensity-adjusted Cox proportional hazard ratios for survival were used to account for indication bias.
Out of 9970 patients with LCNEC of the lung we identified 348 with brain metastases. Sixty-eight patients were treated with upfront SRS and 280 were treated with WBRT. Patients that were treated at an academic facility or received chemotherapy as part of upfront treatment were more likely to receive SRS. Univariable analysis revealed improved outcomes with SRS compared to WBRT, with a median OS of 11 months compared to 6 months, respectively (p = .007). Multivariable Cox regression with propensity score confirmed SRS to have improved survival (HR: 0.68, 95%CI: 0.51-0.91, p = .0093). Multivariable Cox regression with propensity score also identified younger age, receipt of chemotherapy, absence of extracranial disease and non-rural locations as additional predictors of improved OS.
Treatment of brain metastases from LCNEC of the lung with SRS was associated with improved survival. For the appropriate patients, upfront treatment of limited brain metastases with SRS may be appropriate.
肺大细胞神经内分泌癌（LCNEC）是一种罕见的肺部肿瘤，其自然史和治疗策略与小细胞肺癌相似。因此，这些患者的脑转移瘤的治疗方法与小细胞肺癌相似，即采用全脑放疗（WBRT）。我们利用国家癌症数据库（NCDB）研究了预测 LCNEC 脑转移患者接受立体定向放射外科治疗（SRS）的因素，以及 SRS 治疗患者的生存结果是否存在差异。
我们从 2004 年至 2015 年在 NCDB 中查询了患有肺大细胞神经内分泌癌并伴有脑转移且接受脑部放疗的患者。进行单变量和多变量分析以确定 SRS 使用和总生存（OS）的预测因素。使用校正倾向评分的 Cox 比例风险比来评估生存的指示偏差。
在 9970 例肺大细胞神经内分泌癌患者中，我们确定了 348 例有脑转移。68 例患者接受了初始 SRS 治疗，280 例患者接受了 WBRT 治疗。在学术机构接受治疗或作为初始治疗的一部分接受化疗的患者更有可能接受 SRS 治疗。单变量分析显示，与 WBRT 相比，SRS 治疗的结果更好，中位 OS 分别为 11 个月和 6 个月（p = 0.007）。校正倾向评分的多变量 Cox 回归确认 SRS 治疗可改善生存（HR：0.68，95%CI：0.51-0.91，p = 0.0093）。校正倾向评分的多变量 Cox 回归还确定了年龄较小、接受化疗、无颅外疾病和非农村地区是改善 OS 的其他预测因素。
SRS 治疗肺大细胞神经内分泌癌脑转移患者的生存获益更大。对于合适的患者，SRS 可能是治疗局限性脑转移的首选方法。
