Optimal Surgery Type and Adjuvant Therapy for T1N0M0 Lung Large Cell Neuroendocrine Carcinoma

Metastasis pattern and prognosis of large cell neuroendocrine carcinoma: a population-based study

PURPOSE

As a rare type of tumor, the metastasis pattern of large cell neuroendocrine carcinoma (LCNEC) is still unclear. Our aim was to investigate metastatic patterns and develop a predictive model of prognosis in patients with advanced LCNEC.

METHODS

Patients of LCNEC diagnosed between 2010-2015 from the Surveillance, Epidemiology and End Results (SEER) database were retrospectively included. Chi-square test was used for baseline characteristics analysis. Survival differences were assessed using Kaplan-Meier curves. Independent prognostic factors identified by multivariate Cox proportional risk model were used for the construction of nomogram.

RESULTS

557 eligible patients with metastasis LCNEC (median (IQR), 64 (56 to 72) years; 323 males) were included in this research. Among patients with isolated metastases, brain metastases had the highest incidence (29.4%), and multisite metastases had worse OS (HR: 2.020: 95% CI 1.413-2.888; P < 0.001) and LCSS (HR: 2.144, 95% CI 1.480-3.104; P < 0.001) in all age groups. Independent prognostic indicators including age, race, T stage, N stage, chemotherapy, radiotherapy and metastatic site were used for the construction of nomogram. Concordance index (C-index) and decision-curve analyses (DCAs) showed higher accuracy and net clinical benefit of nomogram compared to the 7th TNM staging system (OS: 0.692 vs 0.555; P < 0.001; LCSS: 0.693 vs 0.555; P < 0.001).

CONCLUSIONS

We firstly established a novel comprehensive nomogram to predict the prognosis of metastasis LCNEC. The prognostic model demonstrated excellent accuracy and predictive performance. Chemotherapy and metastasis pattern were the two strongest predictive variables. Close follow-up of patients with LCNEC is necessary to make individualized treatment decisions according to different metastasis patterns.

The Unmet Diagnostic and Treatment Needs in Large Cell Neuroendocrine Carcinoma of the Lung

Large cell neuroendocrine carcinoma of the lung (LCNEC) is currently classified as a rare lung cancer subtype, but given the high incidence of lung cancer, the overall number of cases is considerable. The pathologic diagnosis of LCNEC is mainly based on the microscopic appearance of the tumor cells, the mitotic rate, the amount of intra-tumoral necrosis, and the presence of positive neuroendocrine markers identified by immunohistochemistry. Recently, a subdivision into two main categories was proposed based on mutation signatures involving the RB1, TP53, KRAS, and STK11/LKB1 genes, into SCLC-like (small cell lung cancer-like) and NSCLC-like (non-small cell lung cancer-like) LCNEC. In terms of treatment, surgery is still the best option for resectable, stage I-IIIA cases. Chemotherapy and radiotherapy have conflicting evidence. Etoposide/platinum remains the standard chemotherapy regimen. However, based on the newly proposed LCNEC subtypes, some retrospective series report better outcomes using a pathology-driven chemotherapy approach. Encouraging outcomes have also been reported for immunotherapy and targeted therapy, but the real impact of these strategies is still being determined in the absence of adequate prospective clinical trials. The current paper scrutinized the epidemiology, reviewed the reliability of pathologic diagnosis, discussed the need for molecular subtyping, and reviewed the heterogeneity of treatment algorithms in LCNEC.

Recurrence-Free Survival in Early and Locally Advanced Large Cell Neuroendocrine Carcinoma of the Lung after Complete Tumor Resection

BACKGROUND

Large Cell Neuroendocrine Carcinoma (LCNEC) is a rare subtype of lung cancer with poor clinical outcomes. Data on recurrence-free survival (RFS) in early and locally advanced pure LCNEC after complete resection (R0) are lacking. This study aims to evaluate clinical outcomes in this subgroup of patients and to identify potential prognostic markers.

METHODS

Retrospective multicenter study including patients with pure LCNEC stage I-III and R0 resection. Clinicopathological characteristics, RFS, and disease-specific survival (DSS) were evaluated. Univariate and multivariate analyses were performed.

RESULTS

39 patients (M:F = 26:13), with a median age of 64 years (44-83), were included. Lobectomy (69.2%), bilobectomy (5.1%), pneumonectomy (18%), and wedge resection (7.7%) were performed mostly associated with lymphadenectomy. Adjuvant therapy included platinum-based chemotherapy and/or radiotherapy in 58.9% of cases. After a median follow-up of 44 (4-169) months, the median RFS was 39 months with 1-, 2- and 5-year RFS rates of 60.0%, 54.6%, and 44.9%, respectively. Median DSS was 72 months with a 1-, 2- and 5-year rate of 86.8, 75.9, and 57.4%, respectively. At multivariate analysis, age (cut-off 65 years old) and pN status were independent prognostic factors for both RFS (HR = 4.19, 95%CI = 1.46-12.07, p = 0.008 and HR = 13.56, 95%CI 2.45-74.89, p = 0.003, respectively) and DSS (HR = 9.30, 95%CI 2.23-38.83, p = 0.002 and HR = 11.88, 95%CI 2.28-61.84, p = 0.003, respectively).

CONCLUSION

After R0 resection of LCNEC, half of the patients recurred mostly within the first two years of follow-up. Age and lymph node metastasis could help to stratify patients for adjuvant therapy.