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. 2019 Jun;8(6):2979-2993.
doi: 10.1002/cam4.2188. Epub 2019 May 14.

The demographic and treatment options for patients with large cell neuroendocrine carcinoma of the lung

Jianjun Gu  1 , Daohui Gong  1 , Yuxiu Wang  2 , Beiyuan Chi  2 , Jun Zhang  1 , Suwei Hu  3   4 , Lingfeng Min  1
Affiliations

The demographic and treatment options for patients with large cell neuroendocrine carcinoma of the lung

Jianjun Gu et al. Cancer Med. 2019 Jun.

Abstract

Introduction: Lung large cell neuroendocrine carcinoma (L-LCNEC) is a rare, aggressive tumor, for which the optimal treatment strategies for LCNEC have not yet been established. In order to explore how to improve the outcome of prognosis for patients with LCNEC, this study investigated the effect of different treatments based on the data obtained from the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: A total of 2594 LCNEC cases with conditional information were extracted from SEER database. Propensity Score Matching (PSM) method was conducted to reduce possible bias between groups. One-way ANOVA was used to test the differences of characteristics between groups. Univariate and multivariate Cox proportional hazard models were applied to identify prognostic factors.

Results: Clinicopathologic characteristics including gender, age, TNM stage, T stage, N stage, and M stage were all identified as independent prognostic factors. Surgery benefited stage I, II, and III LCNEC patients' prognoses. The combination treatment that surgery combining with chemotherapy was the optimal treatment for stage I, II, and III LCENC patients. Compared with palliative treatment, stage IV patients obtained better prognoses with the treatment of radiation, chemotherapy, or chemoradiation. When comparing the effect of the three treatments (radiation, chemotherapy, and chemoradiation) in achieving better prognosis for stage IV patients, chemotherapy alone was better than the other treatments.

Conclusion: Surgery combining with chemotherapy was the optimal treatment for stage I, II, and III LCNEC patients; chemotherapy alone achieves more benefit than the other treatments for stage IV patients.

Keywords: chemotherapy; large cell neuroendocrine carcinoma; prognosis; radiation; surgery.

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Conflict of interest statement

There is no conflict of interest in this manuscript.

Figures

Figure 1
Figure 1
Surgery benefited stage I, II, and III LCNEC patients’ prognoses. A, Surgery patients achieved better prognoses than non‐surgery patients in stage I and II LCNEC patients (P = 0.000). B, Surgery patients achieved better prognoses than non‐surgery patients in stage I and II LCNEC patients after PSM was conducted (P = 0.000). C, Surgery patients achieved better prognoses than non‐surgery patients in stage III A LCNEC patients (P = 0.005). D, Surgery patients achieved better prognoses than non‐surgery patients in stage III A LCNEC patients after PSM was conducted (P = 0.001). E, Surgery patients achieved better prognoses than non‐surgery patients in stage III B LCNEC patients (P = 0.009). F, Surgery patients achieved better prognoses than non‐surgery patients in stage III B LCNEC patients after PSM was conducted (P = 0.017)
Figure 2
Figure 2
The combination treatment of surgery and chemotherapy benefited stage I, II, and III LCNEC patients better than the other treatments. A, Compared with surgery alone, surgery combining with chemoradiation had no benefit for stage I, II, and III LCNEC patients (P = 0.555). B, Surgery combining with chemoradiation achieved better prognosis than surgery alone in stage I, II, and III LCNEC patients after PSM was conducted (P = 0.044). C, Surgery combining with chemotherapy achieved better prognosis than surgery combining with radiation (P = 0.035). D, Compared with surgery combining with chemoradiation, surgery combining with chemotherapy achieved better prognosis for patients (P = 0.025). E, Surgery combining with chemotherapy did not have significant difference when compared with surgery combining with chemoradiation in improving patients’ prognoses after the differences of variables between the groups were reduced (P = 0.499). F, Survival comparisons between treatments showed surgery combining with chemotherapy have advantage in improving patients’ prognoses than the other treatments (P = 0.033)
Figure 3
Figure 3
The effect of treatments in non‐surgical stage I, II, and III LCNEC patients. A, Radiation achieved better benefit than chemotherapy for the non‐surgical stage I, II, and III LCNEC patients (P = 0.023). B, After the differences of variables between the groups were reduced, compared with chemotherapy, radiation did not showed advantage in proving patients’ prognoses (P = 0.839). C, Chemoradiation achieved better prognosis than chemotherapy alone (P = 0.000). D, Chemoradiation showed advantage than chemotherapy in improving patients’ prognoses after PSM method was conducted (P = 0.003)
Figure 4
Figure 4
Chemotherapy alone achieved better prognosis than the other treatments in Stage IV LCNEC patients. A, Chemotherapy achieved better prognosis than palliative treatment (P = 0.000). B, Chemotherapy achieved better prognosis than palliative treatment after PSM was conducted (P = 0.000). C, Chemotherapy achieved better prognosis than radiation treatment (P = 0.000). D, Chemoradiation achieved better prognosis than radiation (P = 0.000). E, Chemoradiation achieved better prognosis than radiation after PSM was conducted (P = 0.000). F, Chemoradiation did not have advantage than chemotherapy alone in proving patients’ prognoses (P = 0.688)
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