Cancer Institute of People's Liberation Army, Xinqiao Hospital, Army Medical University, Chongqing, China.
Medical English Department, College of Basic Medicine, Army Medical University, Chongqing, China.
Thorac Cancer. 2019 Apr;10(4):751-760. doi: 10.1111/1759-7714.12993. Epub 2019 Feb 7.
The study was conducted to compare the clinicopathological characteristics, survival outcomes, and metastatic patterns between pulmonary large cell neuroendocrine carcinoma (LCNEC) and other non-small cell lung cancer (ONSCLC), and to identify the prognostic factors of LCNEC.
Data of patients diagnosed with LCNEC and ONSCLC from 2004 to 2014 were obtained from the Surveillance, Epidemiology, and End Results dataset. Pearson's chi-square tests were used to compare differences in clinicopathological characteristics. The Kaplan-Meier method was used for survival analysis. A propensity score was used for matching and a Cox proportional hazards model was used for multivariate and subgroup analyses.
A total of 2368 LCNEC cases and 231 672 ONSCLC cases were identified. LCNEC incidence increased slightly over time. Except for marital status, LCNEC patients had obviously different biological features to ONSCLC patients. Survival analysis showed that LCNEC had poorer outcomes than ONSCLC. Multivariate analysis revealed that female gender, black race, surgery, radiation, and chemotherapy were protective factors for LCNEC. Matched subgroup analysis further demonstrated that most subgroup factors favored ONSCLC, especially in early stage. Early-stage LCNEC patients had a higher risk of lung cancer-specific death than early-stage ONSCLC patients. Moreover, metastatic patterns were different between LCNEC and ONSCLC. LCNEC patients with isolated liver metastasis or combined invasion to other organs had poorer survival rates.
LCNEC has totally different clinicopathological characteristics and metastatic patterns to ONSCLC. LCNEC also has poorer survival outcomes, primarily because of isolated liver metastasis or combined invasion to other organs. Most subgroup factors are adverse factors for LCNEC.
本研究旨在比较肺大细胞神经内分泌癌（LCNEC）与其他非小细胞肺癌（NSCLC）的临床病理特征、生存结局和转移模式，并确定 LCNEC 的预后因素。
从 2004 年至 2014 年的监测、流行病学和最终结果（SEER）数据库中获取诊断为 LCNEC 和 NSCLC 的患者数据。采用 Pearson 卡方检验比较临床病理特征的差异。采用 Kaplan-Meier 法进行生存分析。采用倾向评分进行匹配，并采用 Cox 比例风险模型进行多变量和亚组分析。
共纳入 2368 例 LCNEC 病例和 231672 例 NSCLC 病例。LCNEC 的发病率随时间略有增加。除婚姻状况外，LCNEC 患者与 NSCLC 患者的生物学特征明显不同。生存分析显示，LCNEC 的预后明显差于 NSCLC。多变量分析显示，女性、黑种人、手术、放疗和化疗是 LCNEC 的保护因素。匹配亚组分析进一步表明，大多数亚组因素均有利于 NSCLC，尤其是早期 NSCLC。早期 LCNEC 患者的肺癌特异性死亡风险高于早期 NSCLC 患者。此外，LCNEC 与 NSCLC 的转移模式也不同。LCNEC 患者孤立性肝转移或合并其他器官侵犯的患者生存率较低。
LCNEC 与 NSCLC 在临床病理特征和转移模式上存在显著差异。LCNEC 的生存结局较差，主要是由于孤立性肝转移或合并其他器官侵犯。大多数亚组因素是 LCNEC 的不利因素。
