Tsao Ming Sound, Rosenthal Adam, Nicholson Andrew G, Detterbeck Frank, Eberhardt Wilfried E E, Lievens Yolande, Lim Eric, Matilla Jose-Maria, Yatabe Yasushi, Filosso Pier Luigi, Beyruti Ricardo, Nishimura Katherine K, Travis William D, Osarogiagbon Raymond Uyiosa, Rami-Porta Ramon, Rusch Valerie, Asamura Hisao
Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada.
Cancer Research And Biostatistics, Seattle, Washington.
J Thorac Oncol. 2025 Jan 24. doi: 10.1016/j.jtho.2025.01.013.
Pulmonary high-grade neuroendocrine carcinoma (NEC) includes SCLC and large cell NEC (LCNEC). The seventh and eighth editions of the TNM classification for lung cancer confirmed the applicability of this staging system for SCLC. With the proposal of N2 and M1c subcategories for the ninth edition classification, we assessed the applicability to NECs.
The database included NEC cases diagnosed between January 2011 and December 2019. Eligible cases, with valid survival time and eighth edition TNM stage, were classified as pure SCLC, combined SCLC with NSCLC, and LCNEC. Survival was calculated using the Kaplan-Meier method, pairwise differences using a log-rank test, and prognostic groups using a Cox regression analysis.
There were 6181 pure and combined SCLC and 697 LCNEC cases available. For SCLC, survival outcome analyses included 4453 cases with clinical stage and 583 with pathologic stage data. The corresponding numbers for LCNEC were 585 and 508. The SCLC data validated the ninth edition classification for lung cancer, including the proposed new subcategories, N2a, single-station ipsilateral mediastinal or subcarinal lymph node involvement, and N2b, involvement of multiple ipsilateral or subcarinal stations. The data also validated the subcategorization of M1c into M1c1 (multiple lesions in a single extrathoracic organ system) and M1c2 (involvement of multiple extrathoracic organ systems). The LCNEC data were insufficient for complete survival analysis, but the available data reported decreasing survival with increasing clinical and pathologic stages.
The ninth edition TNM classification applies to patients with NEC and is the appropriate standard for use in clinical practice.
肺高级别神经内分泌癌（NEC）包括小细胞肺癌（SCLC）和大细胞神经内分泌癌（LCNEC）。肺癌的TNM分类第七版和第八版证实了该分期系统对SCLC的适用性。随着第九版分类中N2和M1c亚类的提出，我们评估了其对NEC的适用性。
数据库纳入了2011年1月至2019年12月期间诊断的NEC病例。符合条件且生存时间有效、TNM分期为第八版的病例分为纯SCLC、SCLC合并非小细胞肺癌（NSCLC）和LCNEC。采用Kaplan-Meier法计算生存率，用对数秩检验进行两两比较，用Cox回归分析确定预后分组。
共有6181例纯SCLC和合并SCLC病例以及697例LCNEC病例。对于SCLC，生存结局分析纳入了4453例有临床分期数据的病例和583例有病理分期数据的病例。LCNEC的相应病例数分别为585例和508例。SCLC的数据验证了第九版肺癌分类，包括新提出的亚类，即N2a（同侧纵隔或隆突下单个区域淋巴结受累）和N2b（同侧多个区域或隆突下区域受累）。数据还验证了将M1c分为M1c1（单个胸外器官系统内多个病灶）和M1c2（多个胸外器官系统受累）的亚分类。LCNEC的数据不足以进行完整的生存分析，但现有数据显示随着临床和病理分期的增加生存率下降。
第九版TNM分类适用于NEC患者，是临床实践中适用的标准。
