Limonnik Vladimir, Abel Stephen, Finley Gene G, Long Gregory S, Wegner Rodney E
Allegheny Health Network, Department of Internal Medicine, Pittsburgh, PA, United States.
Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Pittsburgh, PA, United States.
Lung Cancer. 2020 Dec;150:107-113. doi: 10.1016/j.lungcan.2020.10.001. Epub 2020 Oct 6.
Large cell neuroendocrine carcinoma (LCNEC) is a rare pulmonary malignancy with clinicopathologic features of both non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Given the paucity of available data regarding LCNEC management, we queried the National Cancer Database (NCDB) to describe trends in management, identify predictors of treatment receipt, and compare outcomes in patients receiving chemotherapy (ChT) and chemoradiotherapy (CRT).
We identified patients with locally advanced (Stage III) LCNEC of the lung treated with definitive ChT or CRT between the years of 2004-2015. Odds ratios were calculated to determine predictors of CRT receipt. Multivariable cox regression was used to determine predictors of overall survival.
Using the above criteria, 5797 patients were identified, 54 % of whom received CRT (n = 3153) while 46 % (n = 2644) received ChT alone. Most patients had T4 (35 %) and N2 (59 %) disease. Median overall survival was 11.9 months (11.3-12.6) in patients receiving ChT compared to 16.1 months (15.4-16.9) in patients receiving CRT (p < 0.0001). Overall survival at 1, 3, and 5 years was 50 %, 20 %, and 13 % versus 60 %, 27 %, and 18 %, in patients receiving ChT and CRT, respectively. Older patients and those with higher comorbidity scores were less likely to receive CRT; whereas patients with higher education level, treatment receipt at an academic/research program facility, N2 disease, and later treatment year were more likely to receive CRT. On multivariable analysis, older age, greater comorbidity score, presence of N2 disease, and presence of T4 disease were all associated with decreased OS. CRT receipt was an independent predictor of increased overall survival.
Definitive CRT was an independent predictor of increased overall survival in patients with locally advanced LCNEC of the lung. Findings from our study may help guide potential areas of future investigation to help define an ideal treatment approach for LCNEC.
大细胞神经内分泌癌（LCNEC）是一种罕见的肺恶性肿瘤，具有非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）的临床病理特征。鉴于关于LCNEC治疗的可用数据匮乏，我们查询了国家癌症数据库（NCDB）以描述治疗趋势，确定接受治疗的预测因素，并比较接受化疗（ChT）和放化疗（CRT）患者的结局。
我们确定了2004年至2015年间接受根治性ChT或CRT治疗的局部晚期（III期）肺LCNEC患者。计算比值比以确定接受CRT的预测因素。多变量cox回归用于确定总生存的预测因素。
根据上述标准，共确定了5797例患者，其中54%（n = 3153）接受了CRT，而46%（n = 2644）仅接受了ChT。大多数患者患有T4（35%）和N2（59%）疾病。接受ChT的患者中位总生存期为11.9个月（11.3 - 12.6），而接受CRT的患者为16.1个月（15.4 - 16.9）（p < 0.0001）。接受ChT和CRT的患者1年、3年和5年总生存率分别为50%、20%和13%，以及60%、27%和18%。老年患者和合并症评分较高的患者接受CRT的可能性较小；而教育水平较高、在学术/研究项目机构接受治疗、患有N2疾病以及治疗年份较晚的患者接受CRT的可能性较大。多变量分析显示，年龄较大、合并症评分较高、存在N2疾病和存在T4疾病均与总生存期降低相关。接受CRT是总生存期增加的独立预测因素。
根治性CRT是局部晚期肺LCNEC患者总生存期增加的独立预测因素。我们研究的结果可能有助于指导未来研究的潜在领域，以帮助确定LCNEC的理想治疗方法。
