BACKGROUND There are limited small, single-institution observational studies examining the role of surgery in large cell lung neuroendocrine cancer (LNEC). We investigated the outcomes of surgery for stage I-IIIA LCNEC using the National Cancer Database (NCDB). METHODS Patients with stage I-IIIA LCNEC were identified in the NCDB (2004-2015), and grouped by treatment: definitive chemoradiation vs. surgery. Overall survival, by stage,was the primary outcome. Outcomes of surgery patients were also compared to those of patients with small or other non-small cell histotypes. RESULTS A total of 6092 patients met criteria: 96%, 94%, 75%, and 62% of patients received surgery for stage I, II, IIIA, and cN2 disease, respectively. Complete resection was achieved in ≥ 85% of patients. Five-year survival for patients undergoing surgery for stage I and II LCNEC was 50% and 45%, respectively. Surgery patients with stage IIIA and N2 disease had 36% and 32% five-year survival. Surgery was associated with a survival benefit compared to stereotactic body radiation (SBRT) in stage I and chemoradiation in patients with stage II-IIIA disease. Patients with LCNEC undergoing surgery generally experienced worse survival, by stage, compared to those with adenocarcinoma but improved survival compared to small cell. Perioperative chemotherapy was associated with improved survival for pathologic stage II-IIIA disease. CONCLUSION Surgery is associated with reasonable outcomes for stage I-IIIA LCNEC, although survival is generally worse compared to adenocarcinoma. Surgery should be offered to medically fit patients with both early and locally advanced LCNEC, with guideline-concordant induction or adjuvant therapy.

中文翻译：

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大细胞肺神经内分泌癌的手术结果


背景 目前，关于手术在大细胞肺神经内分泌癌 (LNEC) 中的作用的小型、单机构观察性研究非常有限。我们使用国家癌症数据库 (NCDB) 研究了 I-IIIA 期 LCNEC 的手术结果。方法 NCDB (2004-2015) 中确定了 I-IIIA 期 LCNEC 患者，并按治疗进行分组：根治性放化疗与手术。按阶段划分的总体生存率是主要结果。还将手术患者的结果与小细胞或其他非小细胞组织型患者的结果进行了比较。结果 共有 6092 名患者符合标准：分别有 96%、94%、75% 和 62% 的患者因 I、II、IIIA 和 cN2 期疾病接受了手术。 ≥85%的患者实现了完全切除。接受 I 期和 II 期 LCNEC 手术的患者的五年生存率分别为 50% 和 45%。 IIIA 期和 N2 期手术患者的五年生存率分别为 36% 和 32%。与 I 期立体定向放射治疗 (SBRT) 和 II-IIIA 期疾病患者的放化疗相比，手术与生存获益相关。与腺癌患者相比，接受手术的 LCNEC 患者的生存期通常较差，但与小细胞癌患者相比，生存期有所改善。围手术期化疗与病理 II-IIIA 期疾病的生存率改善相关。结论 手术与 I-IIIA 期 LCNEC 的合理结局相关，尽管与腺癌相比，生存率通常较差。应为身体健康的早期和局部晚期 LCNEC 患者提供手术，并采用符合指南的诱导或辅助治疗。