Disparity in clinical outcomes between pure and combined pulmonary large-cell neuroendocrine carcinoma: A multi-center retrospective study.,Lung Cancer

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Disparity in clinical outcomes between pure and combined pulmonary large-cell neuroendocrine carcinoma: A multi-center retrospective study.
Lung Cancer ( IF 5.3 ) Pub Date : 2019-11-11 , DOI: 10.1016/j.lungcan.2019.11.004
Jia-Tao Zhang ₁ , Ye Li ₂ , Li-Xu Yan ₃ , Zheng-Fei Zhu ₄ , Xiao-Rong Dong ₅ , Qian Chu ₆ , Lin Wu ₇ , Hong-Mei Zhang ₈ , Chun-Wei Xu ₉ , Gen Lin ₉ , Zong-Yang Yu ₁₀ , Jie Hu ₁₁ , Bo Zhu ₁₂ , Hui-Juan Wang ₁₃ , Fan Yang ₁₄ , Zheng-Bo Song ₁₅ , Zheng-Bo Han ₁₆ , Meng-Xia Li ₁₇ , Jie Lin ₁₈ , Yi-Long Wu ₁ , Jin-Liang Wang ₂ , Wen-Zhao Zhong ₁

Affiliation

Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China.
Department of Oncology, Chinese PLA General Hospital, Oncology Laboratory, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, 100853, China.
Department of Pathology, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200000, China.
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China.
Hunan Cancer Hospital, Changsha, 410000, China.
Department of Clinical Oncology, Xijing Hospital, the Fourth Military Medical University, Xian, 710000, China.
Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350000, China.
Department of Medicine Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, 350025, China.
Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, 200000, China.
Institute of Oncology, Third Inpatient Building of Xinqiao Hospital, Third Military Medical University, Chongqing, 400000, China.
Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450000, China.
Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100000, China.
Zhejiang Cancer Hospital, Hangzhou, 310000, China.
Shengjing Hospital of China Medical University, Shenyang, 110000, China.
Daping Hospital & Institute of Surgery Research, Army Military Medical University, Chongqing, 400000, China.
Key Laboratory for Tumor Molecular Biology of High Education in Yunnan Province, School of Life Sciences, Yunnan University, Kunming, Yunnan, 650091, China.

OBJECTIVES The 2015 World Health Organization classification defines pulmonary large-cell neuroendocrine carcinoma (LCNEC) as a high-grade neuroendocrine carcinoma. However, the clinical characteristics and prognostic factors of pure LCNEC and combined LCNEC remain unclear. Hence, we performed a multi-center retrospective study to compare the clinical outcomes of pure versus combined LCNEC. MATERIALS AND METHODS Data from 381 patients with pulmonary LCNEC admitted to 17 Chinese institutes between 2009 and 2016 were collected retrospectively. Clinical characteristics and prognosis were analyzed among patients receiving adjuvant (adjuvant group; n = 56) and first-line (first-line group; n = 146) chemotherapy, as well as among patients receiving small cell lung cancer (SCLC) and non-SCLC (NSCLC) chemotherapy regimens. The Kaplan-Meier method and multivariable Cox regression were used to identify clinicopathological variables that might influence patient outcomes. RESULTS Expression levels of neuroendocrine markers (synaptophysin, chromogranin-A, CD56) were associated with patients' prognosis in the total study cohort. In the adjuvant group, median disease-free survival was non-significantly longer for SCLC-based regimens than for NSCLC-based regimens (P = 0.112). In the first-line group, median progression-free survival was significantly longer for SCLC-based regimens than for NSCLC-based regimens (11.5 vs. 7.2 months, P = 0.003). Among patients with combined LCNEC, adenocarcinoma was the most common combined component, accounting for 70.0 % of cases. Additionally, median overall survival was non-significantly shorter for combined LCNEC than for pure LCNEC (P = 0.083). CONCLUSION The SCLC regimen is a more effective choice, as either first-line or adjuvant chemotherapy, when compared to the NSCLC regimen for LCNEC treatment. Further studies are needed to clarify the survival differences between patients with pure-, and combined LCNEC.

更新日期：2019-11-11

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