Peng Kunwei, Cao Huijiao, You Yafei, He Wenzhuo, Jiang Chang, Wang Lei, Jin Yanan, Xia Liangping
VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Front Oncol. 2021 Mar 24;11:591823. doi: 10.3389/fonc.2021.591823. eCollection 2021.
The appropriate treatment strategy for T1N0M0 lung large cell neuroendocrine carcinoma (LCNEC) was not well illustrated. We evaluated the efficacy of different surgery types and adjuvant therapy on patients with T1N0M0 LCNEC.
Patients diagnosed T1N0M0 LCNEC from 2004 to 2016 were identified in the surveillance, epidemiology, and end results (SEER) database. Clinical characteristics, treatment and survival data were collected. The efficacy of surgery type and adjuvant therapy stratified by tumor size was assessed. Overall survival(OS) was evaluated by the Kaplan-Meier method, and relevant survival variables were identified by the Cox proportional hazard model.
From 2004 to 2016, 425 patients were included in this study, 253 (59.5%) patients received lobectomy, and 236 (55.5%) patients had 4 or more lymph nodes removed. Patients received lobectomy had better survival than those received sublobar resection(=0.000). No matter tumor size less than 2 cm or 2 to 3 cm, lobectomy was significantly prolonged survival. Compared with no lymph nodes removed, lymph nodes dissection was associated with more remarkable OS(<0.000). 4 or more regional lymph nodes dissection predicted better OS compared with 1 to 3 regional lymph nodes dissection(=0.014). After surgery, adjuvant chemotherapy did not contribute to extended survival in patients with tumor less than 2 cm(=0.658), and possibly for tumor 2 to 3 cm(=0.082). Multivariate analysis showed that age and lobectomy were independent prognostic factors(=0.000).
Our results suggest that lobectomy and lymph nodes dissection were associated with significantly better survival. Extensive regional lymph node dissection(4 or more) was more effective in prolonging survival than 1 to 3 lymph nodes dissection. Adjuvant chemotherapy was not associated with extended survival for tumor less than 2 cm, and possibly for tumor 2 to 3 cm.
T1N0M0期肺大细胞神经内分泌癌（LCNEC）的合适治疗策略尚未得到充分阐明。我们评估了不同手术类型和辅助治疗对T1N0M0期LCNEC患者的疗效。
在监测、流行病学和最终结果（SEER）数据库中识别出2004年至2016年诊断为T1N0M0期LCNEC的患者。收集临床特征、治疗和生存数据。评估按肿瘤大小分层的手术类型和辅助治疗的疗效。采用Kaplan-Meier法评估总生存期（OS），并通过Cox比例风险模型确定相关生存变量。
2004年至2016年，本研究纳入425例患者，253例（59.5%）患者接受肺叶切除术，236例（55.5%）患者切除4个或更多淋巴结。接受肺叶切除术的患者比接受肺段以下切除术的患者生存更好（P=0.000）。无论肿瘤大小小于2 cm还是2至3 cm，肺叶切除术均显著延长生存期。与未切除淋巴结相比，淋巴结清扫与更显著的总生存期相关（P<0.000）。与1至3个区域淋巴结清扫相比，4个或更多区域淋巴结清扫预测总生存期更好（P=0.014）。术后，辅助化疗对肿瘤小于2 cm的患者生存期延长无贡献（P=0.658），对肿瘤为2至3 cm的患者可能也无贡献（P=0.082）。多因素分析显示年龄和肺叶切除术是独立的预后因素（P=0.000）。
我们的结果表明，肺叶切除术和淋巴结清扫与显著更好的生存相关。广泛的区域淋巴结清扫（4个或更多）在延长生存期方面比1至3个淋巴结清扫更有效。辅助化疗与肿瘤小于2 cm患者的生存期延长无关，对肿瘤为2至3 cm的患者可能也无关。
