Yao Anjie, Liang Long, Rao Hanyu, Shen Yilun, Wang Changhui, Xie Shuanshuan
Department of Respiratory Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China.
School of Medicine, Tongji University, Shanghai 200092, China.
Cancers (Basel). 2022 Oct 25;14(21):5231. doi: 10.3390/cancers14215231.
Background: Pulmonary large cell carcinoma, a type of non-small cell lung cancer (NSCLC), is a rare neoplasm with poor prognosis. In this study, our aim was to investigate the impact of radiation sequences with surgery for stage III/IV LCC patients between different age groups, especially in the elderly patients. Patients and Methods: The patients with LCC and other types of NSCLC in the Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2015 were retrospectively analyzed. Then we divided the LCC patients into two age groups: <65 years old group and ≥65 years old group. Propensity score method (PSM) was used to control potential differences between different groups. The overall survival (OS) of LCC patients and other types of NSCLC patients were evaluated by Kaplan−Meier analysis. Univariate and multivariate Cox regression analysis were employed to explore the independent risk factors of OS. The forest plots of HRs for OS were generated to show the above outcomes more visually. Results: In total, 11,349 LCC patients and 129,118 other types of NSCLC patients were enrolled in this study. We divided LCC patients into <65 years old group (4300) and ≥65 years old group (7049). LCC patients was more common in whites (81.4%), males (58.3%), elderly (≥65 years old: 62.1%), east regions (52.7%), upper lobe (51.6%), right-origin of primary (55.4%), with advanced grade (54.2%) or stage (76.7%). After PSM, Kaplan−Meier analysis and multivariate Cox analysis showed significantly worse survival prognosis for LCC patients compared to other types of NSCLC, especially in the group ≥65 years old (HR: 1.230; 95% CI: 1.171−1.291; p < 0.001). For LCC patients, there were some risk survival factors including whites, males, not upper lobe, advanced stage, elder age at diagnosis, bone metastasis, liver metastasis, singled status, no lymphadenectomy, no surgery, and no chemotherapy (p < 0.05). In LCC patients ≥65 years old, radiation after surgery had significantly better impact on overall survival outcomes (HR: 0.863, 95% CI: 0.765−0.973, p = 0.016), whereas radiation prior to surgery (HR: 1.425, 95% CI: 1.059−1.916, p = 0.019) had significantly worse impact on prognosis of patients. In LCC patients <65 years old, radiation sequences with surgery had no significant impact on the OS of patients (p = 0.580), but ≥4 LNRs had significantly survival benefits to prognosis (HR:0.707, 95% CI: 0.584−0.855). Elderly LCC patients had worse malignant tumors than young patients, of which the majority were diagnosed as stage III/IV tumors. Conclusions: Postoperative radiotherapy may achieve a better prognosis for stage III/IV LCC patients older than 65 years old compared to other radiation sequences with surgery.
肺大细胞癌是一种非小细胞肺癌（NSCLC），是一种罕见的肿瘤，预后较差。在本研究中，我们的目的是调查不同年龄组的Ⅲ/Ⅳ期肺大细胞癌（LCC）患者手术联合放疗顺序的影响，特别是老年患者。
回顾性分析2004年至2015年监测、流行病学和最终结果（SEER）数据库中LCC及其他类型NSCLC患者。然后我们将LCC患者分为两个年龄组：<65岁组和≥65岁组。采用倾向评分法（PSM）控制不同组之间的潜在差异。通过Kaplan-Meier分析评估LCC患者和其他类型NSCLC患者的总生存期（OS）。采用单因素和多因素Cox回归分析探讨OS的独立危险因素。生成OS的HR森林图，以更直观地展示上述结果。
本研究共纳入11349例LCC患者和129118例其他类型NSCLC患者。我们将LCC患者分为<65岁组（4300例）和≥65岁组（7049例）。LCC患者在白人（81.4%）、男性（58.3%）、老年人（≥65岁：62.1%）、东部地区（52.7%）、上叶（51.6%）、原发于右侧（55.4%）、高级别（54.2%）或晚期（76.7%）中更为常见。PSM后，Kaplan-Meier分析和多因素Cox分析显示，与其他类型NSCLC患者相比，LCC患者的生存预后明显更差，尤其是在≥65岁组（HR：1.230；95%CI：1.171-1.291；p<0.001）。对于LCC患者，存在一些生存危险因素，包括白人、男性、非上叶、晚期、诊断时年龄较大、骨转移、肝转移、单身状态、未行淋巴结清扫术、未行手术和未行化疗（p<0.05）。在≥65岁的LCC患者中，术后放疗对总生存结局有显著更好的影响（HR：0.863，95%CI：0.765-0.973，p=0.016），而术前放疗（HR：1.425，95%CI：1.059-1.916，p=0.019）对患者预后有显著更差的影响。在<65岁的LCC患者中，手术联合放疗顺序对患者的OS没有显著影响（p=0.580），但≥4个LNR对预后有显著的生存益处（HR：0.707，95%CI：0.584-0.855）。老年LCC患者的恶性肿瘤比年轻患者更严重，其中大多数被诊断为Ⅲ/Ⅳ期肿瘤。
与其他手术联合放疗顺序相比，术后放疗可能使65岁以上的Ⅲ/Ⅳ期LCC患者获得更好的预后。
