May Michael S, Kinslow Connor J, Adams Christopher, Saqi Anjali, Shu Catherine A, Chaudhary Kunal R, Wang Tony J C, Cheng Simon K
Department of Internal Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
Transl Lung Cancer Res. 2021 Jan;10(1):71-79. doi: 10.21037/tlcr-20-374.
Treatment paradigms for large cell neuroendocrine carcinoma (LCNEC) of the lung are based largely upon small retrospective studies and smaller prospective trials. It is unclear if these tumors behave like non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). Data are lacking with regard to the role of radiotherapy (RT). U. S. guidelines recommend that LCNEC be treated as a NSCLC. We sought to perform a cross-sectional study of LCNEC cases to understand treatment paradigms and outcomes in this disease.
The Surveillance, Epidemiology and End Results database was queried for cases of stage I-III pulmonary LCNEC diagnosed 2004-2013. Treatment groups were defined as no surgery, RT alone, surgery alone, and surgery + RT. The Cox-proportional hazards regression model was used to compare overall survival and cause-specific survival (OS/CSS), stratified by AJCC 6th Staging. Factors that were significant on univariable analysis were included in multivariable analysis.
We identified 1,523 cases of LCNEC, with 748, 177, and 598 cases of stage I, II, and III disease, respectively. In stage I and II disease, RT was associated with improved survival for non-surgical patients, but not for those who underwent surgery. In stage I disease, the adjusted hazard ratios for OS for RT alone, surgery, and surgery + RT were 0.39, 0.21, and 0.22, respectively (P<0.001). In stage II disease, the adjusted hazard ratios for RT alone, surgery, and surgery + RT were 0.51 (P=0.15), 0.39 (P=0.004), and 0.38 (P=0.01), respectively. For patients with stage III disease, RT was associated with improved survival in surgical and non-surgical patients. The adjusted hazard ratios for RT alone, surgery, and surgery + RT were 0.49, 0.43, and 0.36, respectively (P<0.001).
Our findings indicate that non-metastatic LCNEC may be treated as a NSCLC with respect to RT. Prospective studies are necessary to increase our understanding of optimal treatment regimens.
肺大细胞神经内分泌癌（LCNEC）的治疗模式很大程度上基于小型回顾性研究和规模较小的前瞻性试验。目前尚不清楚这些肿瘤的行为表现更像非小细胞肺癌（NSCLC）还是小细胞肺癌（SCLC）。关于放射治疗（RT）的作用，相关数据匮乏。美国指南建议将LCNEC作为NSCLC进行治疗。我们试图对LCNEC病例进行横断面研究，以了解该疾病的治疗模式和预后情况。
查询监测、流行病学与最终结果数据库，获取2004年至2013年诊断为I - III期肺LCNEC的病例。治疗组定义为未手术、单纯放疗、单纯手术以及手术 + 放疗。采用Cox比例风险回归模型比较总生存期和病因特异性生存期（OS/CSS），并根据美国癌症联合委员会（AJCC）第6版分期进行分层。单变量分析中有显著意义的因素纳入多变量分析。
我们共识别出1523例LCNEC病例，其中I期、II期和III期疾病分别有748例、177例和598例。在I期和II期疾病中，放疗可提高未手术患者的生存率，但对接受手术的患者无此作用。在I期疾病中，单纯放疗、手术以及手术 + 放疗的OS调整后风险比分别为0.39、0.21和0.22（P<0.001）。在II期疾病中，单纯放疗、手术以及手术 + 放疗的调整后风险比分别为0.51（P = 0.15）、0.39（P = 0.004）和0.38（P = 0.01）。对于III期疾病患者，放疗可提高手术和未手术患者的生存率。单纯放疗、手术以及手术 + 放疗的调整后风险比分别为0.49、0.43和0.36（P<0.001）。
我们的研究结果表明，对于非转移性LCNEC，在放疗方面可将其视为NSCLC进行治疗。有必要开展前瞻性研究以加深我们对最佳治疗方案的理解。
