Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Eur J Cardiothorac Surg. 2022 Jul 11;62(2). doi: 10.1093/ejcts/ezac069.
Combined large cell neuroendocrine carcinoma (C-LCNEC) is pulmonary large cell neuroendocrine carcinoma (LCNEC) mixed with other components, such as adenocarcinoma (AD) and squamous cell carcinoma (SCC). This study aimed to describe the distinct features between C-LCNEC with different components and explore the treatment strategy.
We retrospectively collected data of 96 C-LCNEC patients who underwent surgical resection. Propensity score matching was used to balance baseline characteristics of LCNEC combined with AD (LCNEC/AD) and LCNEC combined with SCC (LCNEC/SCC).
In our final cohort, 71 (74%) were LCNEC/AD, while 25 (26%) were LCNEC/SCC. LCNEC/AD was more likely to occur in female, younger adults, with visceral pleural invasion and with driver gene expression. However, there was no significant difference in disease-free survival and overall survival between the 2 groups (before matching: P = 0.79 and P = 0.85; after matching: P = 0.87 and P = 0.48), while adjuvant chemotherapy (P = 0.019 and P = 0.043) was an independent predictor. C-LCNEC patients of stage II or III receiving adjuvant chemotherapy had longer disease-free survival and overall survival (P = 0.054 and P = 0.025), and the benefit of etoposide-based chemotherapy was greater than the other regimens (P = 0.010 and P = 0.030). EGFR and ALK mutations were present in 28% (17/60) and 7% (4/60) of C-LCNEC patients, respectively, and they responded well to targeted therapy.
LCNEC/AD was the most common type of C-LCNEC, and there were many differences between different combined components. Adjuvant chemotherapy, especially etoposide-based chemotherapy, was a beneficial option for resected C-LCNEC.Subj collection: 152.
大细胞神经内分泌癌（LCNEC）合并其他成分（如腺癌（AD）和鳞状细胞癌（SCC））被称为复合大细胞神经内分泌癌（C-LCNEC）。本研究旨在描述不同成分的 C-LCNEC 之间的显著特征，并探讨其治疗策略。
我们回顾性收集了 96 例接受手术切除的 C-LCNEC 患者的数据。采用倾向评分匹配法平衡 LCNEC 合并 AD（LCNEC/AD）和 LCNEC 合并 SCC（LCNEC/SCC）的基线特征。
在最终的队列中，71 例（74%）为 LCNEC/AD，25 例（26%）为 LCNEC/SCC。LCNEC/AD 更可能发生在女性、年轻患者中，且易发生内脏胸膜侵犯和驱动基因表达。然而，两组患者的无病生存期和总生存期无显著差异（匹配前：P=0.79 和 P=0.85；匹配后：P=0.87 和 P=0.48），而辅助化疗（P=0.019 和 P=0.043）是独立的预测因素。接受辅助化疗的 II 期或 III 期 C-LCNEC 患者无病生存期和总生存期更长（P=0.054 和 P=0.025），且依托泊苷为基础的化疗方案的获益大于其他方案（P=0.010 和 P=0.030）。在 60 例 C-LCNEC 患者中，分别有 28%（17/60）和 7%（4/60）的患者存在 EGFR 和 ALK 突变，他们对靶向治疗反应良好。
LCNEC/AD 是 C-LCNEC 最常见的类型，不同组合成分之间存在许多差异。辅助化疗，尤其是依托泊苷为基础的化疗，是切除后 C-LCNEC 的有益选择。
