Department of Pulmonology, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Jagiellonska 78, 11-041 Olsztyn, Poland.
Department of Oncology and Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland Roentgena 5, 02-781 Warsaw, Poland.
Medicina (Kaunas). 2021 Jan 28;57(2):118. doi: 10.3390/medicina57020118.
: Large cell neuroendocrine cancer is characterised by poor prognosis. The standard of treatment is still not established. The aim of this study was to assess the predictive factors of overall survival (OS) and progression-free survival (PFS) of pulmonary large cell neuroendocrine carcinoma (LCNEC) and combined LCNEC. : All patients had confirmed pathology stage I-IV disease recorded between period 2002-2018. Survival curves were estimated by Kaplan-Meier method. Uni- and multivariable analysis was conducted using Cox-regression analysis. : A total of 132 patients with LCNEC and combined LCNEC were included. Half of them had clinical stage IIIB/C-IV. Patients were treated with radical ( = 67, including surgery alone; resection with neo-adjuvant or adjuvant chemotherapy, radiochemotherapy, or adjuvant radiotherapy; patients treated with radiochemotherapy alone), palliative ( = 41) or symptomatic ( = 24) intention. Seventeen patients were treated with resection margin R1 or R2. Non-small cell carcinoma (NSCLC) chemotherapy (platinum-vinorelbine; PN schedule) and small-cell lung carcinoma (SCLC) chemotherapy approaches (platinum/carboplatinum-etoposide; PE/KE schedule) were administered in 20 and in 55 patients, respectively. The median (95% Confidence Interval (CI)) OS and PFS were 17 months (9.0-36.2 months) and 7 months (3.0-15.0 months), respectively. Patients treated with negative resection margin, with lower clinical stage, without lymph node metastasis, and with size of primary tumour ≤4 cm showed significantly better OS and PFS. The main risk factors with an adverse effect on survival were advanced CS and positive resection margin. : Patients with LCNEC characterized poor prognosis. Independent prognostic factors influencing PFS were initial clinical stage and resection margin R0 vs. R1-2.
大细胞神经内分泌癌的预后较差。目前尚未确立其标准治疗方法。本研究旨在评估肺大细胞神经内分泌癌（LCNEC）和合并 LCNEC 的总生存期（OS）和无进展生存期（PFS）的预测因素。
所有患者均经病理学证实为 2002-2018 年期间的 I-IV 期疾病。采用 Kaplan-Meier 法估计生存曲线。采用 Cox 回归分析进行单变量和多变量分析。
共纳入 132 例 LCNEC 和合并 LCNEC 患者，其中半数患者为 IIIB/C-IV 期临床期别。患者接受根治性（=67 例，包括手术单独治疗；手术联合新辅助或辅助化疗、放化疗或辅助放疗；单独接受放化疗治疗）、姑息性（=41 例）或对症性（=24 例）治疗。17 例患者行切缘 R1 或 R2 切除术。20 例患者接受非小细胞肺癌（NSCLC）化疗（顺铂-长春瑞滨；PN 方案），55 例患者接受小细胞肺癌（SCLC）化疗方案（顺铂/卡铂-依托泊苷；PE/KE 方案）。中位（95%置信区间（CI））OS 和 PFS 分别为 17 个月（9.0-36.2 个月）和 7 个月（3.0-15.0 个月）。切缘阴性、临床期别较低、无淋巴结转移和原发肿瘤直径≤4cm 的患者 OS 和 PFS 显著更好。对生存有不利影响的主要危险因素是晚期 CS 和阳性切缘。
LCNEC 患者预后较差。影响 PFS 的独立预后因素为初始临床期别和 R0 与 R1-2 切缘。
