Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Denmark; ENETS Neuroendocrine Tumor Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark.
Surg Oncol. 2022 May;41:101728. doi: 10.1016/j.suronc.2022.101728. Epub 2022 Feb 16.
Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a rare subtype of lung cancer with dismal prognosis. Long-term outcomes after primarily video-assisted thoracoscopic surgery (VATS) have not yet been described in LCNEC. This study aims to determine overall survival and recurrence-free survival after VATS as well as to identify prognostic factors for survival and recurrence.
Data were obtained from a prospective institutional database. Kaplan-Meier estimates of overall survival and recurrence-free survival were determined and compared across prognostic factors using log-rank analysis and the Cox proportional hazards model.
Data from 82 consecutive patients undergoing surgical resection from 2009 to 2020 were included. All patients underwent surgical resection with curative intent, of whom 96.3% were by a VATS approach. Morbidity was low without any conversions or 30-day mortality. Lobectomy was performed in 87.8% of patients, followed by wedge resection in 4.9% and segmentectomy in 3.7%. No pneumonectomies were performed. Radical resection (R0) was achieved in 97.6%. Thirty-four patients (41.5%) had adjuvant platinum-based chemotherapy and high proportion completed at least four series (76.7%). The mean follow-up was 5.1 years. The 1-year, 3-year, and 5-year overall survival rates were 86%, 54%, and 45%, while the corresponding recurrence-free survival rates were 67%, 45%, and 35%. Advanced age was an independent predictor of poor overall survival (HR 2.08; 95% CI 1.04-4.17; p = 0.038).
A 96.3% VATS rate was feasible in LCNEC and associated with a low morbidity rate and a high compliance with adjuvant chemotherapy. Overall survival and recurrence-free survival was comparable to previous series using thoracotomy.
肺大细胞神经内分泌癌（LCNEC）是一种罕见的肺癌亚型，预后较差。尚未有研究描述 LCNEC 患者行电视辅助胸腔镜手术（VATS）后的长期结果。本研究旨在确定 VATS 后的总生存率和无复发生存率，并确定与生存和复发相关的预后因素。
数据来自一个前瞻性的机构数据库。使用对数秩分析和 Cox 比例风险模型，根据预后因素确定并比较 Kaplan-Meier 总生存率和无复发生存率。
纳入了 2009 年至 2020 年期间 82 例连续接受手术切除的患者的数据。所有患者均行根治性手术切除，其中 96.3%的患者采用 VATS 方法。术后并发症发生率低，无中转开胸或 30 天内死亡病例。87.8%的患者行肺叶切除术，4.9%的患者行楔形切除术，3.7%的患者行肺段切除术。无全肺切除术。97.6%的患者达到了根治性切除（R0）。34 例（41.5%）患者接受了含铂类的辅助化疗，且大多数患者（76.7%）完成了至少 4 个疗程。平均随访时间为 5.1 年。1 年、3 年和 5 年的总生存率分别为 86%、54%和 45%，相应的无复发生存率分别为 67%、45%和 35%。高龄是总生存不良的独立预测因素（HR 2.08；95%CI 1.04-4.17；p=0.038）。
在 LCNEC 中，VATS 使用率达到 96.3%，且并发症发生率低，对辅助化疗的依从性高。总生存率和无复发生存率与以往的剖胸手术系列结果相当。
