Infectious Department, The Affiliated People's Hospital of Ningbo University, Yinzhou People's Hospital, Ningbo, 315040, P. R. China.
Hematological Department, The Affiliated People's Hospital of Ningbo University, Yinzhou People's Hospital, Ningbo, 315040, P. R. China.
J Cardiothorac Surg. 2023 Jul 5;18(1):216. doi: 10.1186/s13019-023-02314-1.
This study aimed to investigate the prognostic significance of surgery in large-cell neuroendocrine carcinoma (LCNC) patients.
A total of 453 patients from the Surveillance, Epidemiology, and End Results database diagnosed with stage T1-4N0-2M0 LCNC from 2010 to 2015 were analyzed. The propensity-score matching analysis with a ratio of 1:1 was used to minimize the bias effect of other clinical characteristics, and 77 pairs of patients' data were performed for subsequent statistical analysis. The Cox proportional hazards model, Kaplan-Meier analysis, and Log-rank test were used in the present study. The primary observational endpoint was cancer-specific survival (CSS).
The 1-year, 3-year, and 5-year CSS rates were 60.0%, 45.0%, and 42.0% in those 453 LCNC patients. Compared with patients who underwent surgical resection, patients without surgery had a lower 5-year CSS rate (18.0% vs. 52.0%, P < 0.001). After analyses of multivariable Cox regression, chemotherapy, T stage, N stage, and surgery were identified as independent prognostic indicators (all P < 0.05). In the cohort of old patients, the median survival time was longer in cases after surgery than those without surgery (13.0 months vs. NA, P < 0.001). Besides, in patients with different clinical characteristics, the receiving surgery was a protective prognostic factor (all hazard ratio < 1, all P < 0.05). In addition, for the cohort with stage T1-2N0-2M0, patients after the operation had more improved outcomes than patients without surgery (P < 0.001).
We proposed that the surgery could improve the survival outcomes of LCNC patients with stage T1-4N0-2M0. Moreover, old patients could benefit from surgery.
本研究旨在探讨手术对大细胞神经内分泌癌（LCNC）患者的预后意义。
从 2010 年至 2015 年，分析了监测、流行病学和最终结果数据库中诊断为 T1-4N0-2M0 期 LCNC 的 453 例患者。采用 1:1 的倾向评分匹配分析，以最小化其他临床特征的偏倚效应，并对 77 对患者的数据进行了后续统计分析。本研究采用 Cox 比例风险模型、Kaplan-Meier 分析和 Log-rank 检验。主要观察终点为癌症特异性生存（CSS）。
453 例 LCNC 患者的 1 年、3 年和 5 年 CSS 率分别为 60.0%、45.0%和 42.0%。与接受手术切除的患者相比，未接受手术的患者 5 年 CSS 率较低（18.0% vs. 52.0%，P<0.001）。多变量 Cox 回归分析后，化疗、T 分期、N 分期和手术被确定为独立的预后指标（均 P<0.05）。在老年患者队列中，手术后患者的中位生存时间长于未手术患者（13.0 个月 vs. NA，P<0.001）。此外，在具有不同临床特征的患者中，手术是一种保护预后因素（所有风险比<1，均 P<0.05）。此外，对于 T1-2N0-2M0 期患者，手术后患者的预后优于未手术患者（P<0.001）。
我们提出手术可以改善 T1-4N0-2M0 期 LCNC 患者的生存结局。此外，老年患者可以从手术中获益。
