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Zhou H, Gao P, Liu F, Shi L, Sun L, Zhang W, Xu X, Liu X. Development and validation of a novel nomogram to predict the overall survival of patients with large cell lung cancer: A surveillance, epidemiology, and end results population-based study. Heliyon 2023; 9:e15924. [PMID: 37223713 PMCID: PMC10200837 DOI: 10.1016/j.heliyon.2023.e15924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
Background Large cell lung cancer (LCLC) is a rare subtype of non-small cell lung carcinoma (NSCLC), and little is known about its clinical and biological characteristics. Methods LCLC patient data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. All patients were randomly divided into a training group and a validation group at a ratio of 7:3. The independent prognostic factors that were identified (P < 0.01) by stepwise multivariate Cox analysis were incorporated into an overall survival (OS) prediction nomogram, and risk-stratification systems, C-index, time-ROC, calibration curve, and decision curve analysis (DCA) were applied to evaluate the quality of the model. Results Nine factors were incorporated into the nomogram: age, sex, race, marital status, 6th AJCC stage, chemotherapy, radiation, surgery and tumor size. The C-index of the predicting OS model in the training dataset and in the test dataset was 0.757 ± 0.006 and 0.764 ± 0.009, respectively. The time-AUCs exceeded 0.8. The DCA curve showed that the nomogram has better clinical value than the TNM staging system. Conclusions Our study summarized the clinical characteristics and survival probability of LCLC patients, and a visual nomogram was developed to predict the 1-year, 3-year and 5-year OS of LCLC patients. This provides more accurate OS assessments for LCLC patients and helps clinicians make personal management decisions.
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Affiliation(s)
- Hongxia Zhou
- Department of Nephrology, The 908th Hospital of the People's Liberation Army Joint Logistics Support Force, The Great Wall Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi 330006, China
| | - Pengxiang Gao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Fangpeng Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Liangliang Shi
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Longhua Sun
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Wei Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
- Jiangxi Institute of Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
- Jiangxi Clinical Research Center for Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Xinping Xu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
- Jiangxi Institute of Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
- Jiangxi Clinical Research Center for Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province 330006, China
| | - Xiujuan Liu
- Department of Nephrology, The 908th Hospital of the People's Liberation Army Joint Logistics Support Force, The Great Wall Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi 330006, China
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Wei X, Wei Z, Zheng G, Xie T, Huo Z, Huang Y, Chen X, Bai J. Prognostic significance of circulating Epstein-Barr virus DNA in pulmonary lymphoepithelioma-like carcinoma: A meta-analysis and validation study. J Med Virol 2023; 95:e28349. [PMID: 36428250 DOI: 10.1002/jmv.28349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/05/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
In small-scale studies, circulating Epstein-Barr virus (EBV) DNA levels have prognostic value in patients with pulmonary lymphoepithelioma-like carcinoma (LELC). Therefore, we performed a comprehensive meta-analysis to evaluate the prognostic significance of circulating EBV DNA levels in patients with pulmonary LELC. Studies that discussed the prognostic significance of circulating EBV DNA detection in pulmonary LELC were eligible for inclusion in this study. The overall survival (OS) and progression-free survival (PFS) were the primary outcomes. Pooled hazard ratio (HR), 95% confidence intervals (CIs), and p value were calculated to estimate the prognostic significance of EBV DNA levels. Additionally, we conducted a further observation using an independent cohort. The pooled HR and 95% CI of pretreatment EBV DNA levels for OS and PFS were 3.63 (95% CI: 2.90-4.55) and 2.88 (95% CI: 1.90-4.38), respectively. The pooled HR and 95% CI for Posttreatment EBV DNA levels for OS and PFS were 3.77 (95% CI: 2.96-4.80) and 3.52 (95% CI: 1.91-6.51, p < 0.001), respectively. The independent cohort showed similar results that patients with high pretreatment EBV DNA or positive posttreatment EBV DNA had significantly inferior PFS. Circulating EBV DNA levels provide prognostic values of survival and treatment response in pulmonary LELC patients.
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Affiliation(s)
- Xinyan Wei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zuyou Wei
- Department of Respiratory and Critical Care Medicine, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Guixian Zheng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ting Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zengyu Huo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yanbing Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoli Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jing Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Yang L, Fan Y, Lu H. Pulmonary Large Cell Neuroendocrine Carcinoma. PATHOLOGY AND ONCOLOGY RESEARCH 2022; 28:1610730. [PMID: 36304941 PMCID: PMC9592721 DOI: 10.3389/pore.2022.1610730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022]
Abstract
Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare subtype of malignant pulmonary tumor. The incidence rate of LCNEC was reported to be 0.3%–3% in lung cancers. Although LCNEC is classified as non-small cell lung cancer (NSCLC), it is more aggressive and malignant than other NSCLC, and its biological behavior is similar to that of small cell lung cancer (SCLC). Most of the LCNEC patients are elderly smoking male and the clinical manifestations are not specific. The imaging manifestations of the tumors are often located in the periphery and the upper lobes, and the enlargement of mediastinal or hilar lymph nodes is common. The diagnosis is mainly based on pathology by the histological features and immunohistochemistry (IHC). Specific neuroendocrine markers such as chromogranin A (CgA), synaptophysin (Syn) and CD56 are usually diffusely positive in LCNEC, and found that insulinoma-associated protein (INSM1) and high rate of Ki-67 are helpful for diagnosis. More differential diagnoses also increase the difficulty of correctly diagnosing LCNEC. The rise of LCNEC molecular typing in recent years may be helpful for diagnosis and subsequent treatment. This review focuses on the epidemiological features, imaging studies, pathology, diagnosis, treatment, and prognosis of LCNEC.
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Affiliation(s)
- Lan Yang
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Ying Fan
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Hongyang Lu,
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Atieh T, Huang CH. Treatment of Advanced-Stage Large Cell Neuroendocrine Cancer (LCNEC) of the Lung: A Tale of Two Diseases. Front Oncol 2021; 11:667468. [PMID: 34178652 PMCID: PMC8226095 DOI: 10.3389/fonc.2021.667468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023] Open
Abstract
LCNEC of the lung comprises a small proportion of pulmonary malignancies. Traditionally, they have been classified based on histologic and immunohistochemistry characteristics with features of small cell and non-small cell lung cancer. The treatment outcome of advanced-stage LCNEC of the lung is poor with response rates ranging from 34 to 46% with platinum doublets, median progression-free survival (mPFS) ranging between 4.4 and 5.8 m, and median overall survival (mOS) ranging from 8 to 12.6 m. The optimal treatment strategy for LCNEC is debated given limited data and different outcomes based on chemotherapy type reported in the available literature. Recently, genomic profiling with Next Generation Sequencing (NGS) has been able to sub-classify LCNEC as SCLC-like or NSCLC-like. Treatment based on this sub-classification has improved outcomes by using SCLC and NSCLC regimens based on their genomic profile in retrospective analysis. Future studies in LCNEC of the lung should incorporate this new molecular sub-classification as stratification and possibly include SCLC-like LCNEC into SCLC studies and NSCLC-like into NSCLC studies.
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Affiliation(s)
- Tahani Atieh
- Division of Medical Oncology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Chao H Huang
- Division of Medical Oncology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States.,Subpecialty Medicine, Kansas City VA Medical Center, Kansas City, MO, United States
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Lin G, Qi K, Liu B, Liu H, Li J. A nomogram prognostic model for large cell lung cancer: analysis from the Surveillance, Epidemiology and End Results Database. Transl Lung Cancer Res 2021; 10:622-635. [PMID: 33718009 PMCID: PMC7947411 DOI: 10.21037/tlcr-19-517b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Currently, there is no reliable method for predicting the prognosis of patients with large cell lung cancer (LCLC). The aim of this study was to develop and validate a nomogram model for accurately predicting the prognosis of patients with LCLC. Methods LCLC patients, diagnosed from 2007 to 2009, were identified from the Surveillance, Epidemiology and End Results (SEER) database and used as the training dataset. Significant clinicopathologic variables (P<0.05) in a multivariate Cox regression were selected to build the nomogram. The performance of the nomogram model was evaluated by the concordance index (C-index), the area under the curve (AUC), and internal calibration. LCLC patients diagnosed from 2010 to 2016 in the SEER database were selected as a testing dataset for external validation. The nomogram model was also compared with the currently used American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system (8th edition) by using C-index and a decision curve analysis. Results Eight variables-age, sex, race, marital status, T stage, N stage, M stage, and treatment strategy-were statistically significant in the multivariate Cox model and were selected to develop the nomogram model. This model exhibited excellent predictive performance. The C-index and AUC value were 0.761 [95% confidence interval (CI), 0.754 to 0.768] and 0.886 for the training dataset and 0.773 (95% CI, 0.765 to 0.781) and 0.876 for the testing dataset, respectively. This model also predicted three-year and five-year lung cancer-specific survival (LCSS) in both datasets with good fidelity. This nomogram model performs significantly better than the 8th edition AJCC TNM staging system, with a higher C-index (P<0.001) and better net benefits in predicting LCSS in LCLC patients. Conclusions We developed and validated a prognostic nomogram model for predicting 3- and 5-year LCSS in LCLC patients with good discrimination and calibration abilities. The nomogram may be useful in assisting clinicians to make individualized decisions for appropriate treatment in LCLC.
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Affiliation(s)
- Gang Lin
- Department of Thoracic Surgery, Peking University First Affiliated Hospital, Peking University, Beijing, China
| | - Kang Qi
- Department of Thoracic Surgery, Peking University First Affiliated Hospital, Peking University, Beijing, China
| | - Bing Liu
- Department of Thoracic Surgery, Peking University First Affiliated Hospital, Peking University, Beijing, China
| | - Haibo Liu
- Department of Thoracic Surgery, Peking University First Affiliated Hospital, Peking University, Beijing, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University First Affiliated Hospital, Peking University, Beijing, China
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Cao L, Wu HF, Zhao L, Bai Y, Jiang ZL, Yang WJ, Liu SX. The role of radiotherapy in pulmonary large cell neuroendocrine carcinoma: propensity score matching analysis. JOURNAL OF RADIATION RESEARCH 2020; 61:594-601. [PMID: 32567658 PMCID: PMC7336819 DOI: 10.1093/jrr/rraa036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/02/2020] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Abstract
The aim of the study was to investigate the survival advantage of radiotherapy (RT) in patients with pulmonary large cell neuroendocrine carcinoma (LCNEC). Patients with pulmonary LCNEC were extracted from the Surveillance, Epidemiology, and End Results (SEER) dataset between January 2004 and December 2013. Propensity score matching (PSM) analysis with 1:1 was used to ensure well-balanced characteristics of all comparison groups. A total of 1480 eligible cases were identified, with a median follow-up time of 11 months (0-131 months). After PSM, 980 patients were classified in no radiotherapy (No RT) and radiotherapy (RT) groups (n = 490 each). Patients in the RT group harbored significantly higher 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates compared to those in the No RT group (both P < 0.05). Furthermore, RT was an independent favorable prognostic factor of OS as well as CSS in multivariate analysis, both before [OS: hazard ratio (HR) 0.840, 95% confidence interval (CI) 0.739-0.954, P = 0.007; CSS: HR 0.847, 95% CI 0.741-0.967, P = 0.014] and after (OS: HR 0.854, 95% CI 0.736-0.970, P = 0.016; CSS: HR 0.848, 95% CI 0.735-0.978, P = 0.023) PSM. In subgroup analysis, American Joint Committee on Cancer (AJCC) stage II and III, tumor size 5-10 cm, patients who underwent no surgery, or patients who received chemotherapy could significantly benefit from RT (all P < 0.05). To sum up, our findings suggested that RT could prolong the survival of patients with pulmonary LCNEC, especially those with stage II and III, tumor size 5-10 cm, those with no surgery, or those who received chemotherapy.
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Affiliation(s)
- Ling Cao
- Department of Radiation Oncology, Jilin Provincial Cancer Hospital, Changchun, 130012, China
| | - Hong-Fen Wu
- Department of Radiation Oncology, Jilin Provincial Cancer Hospital, Changchun, 130012, China
| | - Ling Zhao
- Department of Radiation Oncology, Jilin Provincial Cancer Hospital, Changchun, 130012, China
| | - Yan Bai
- Department of Radiation Oncology, Jilin Provincial Cancer Hospital, Changchun, 130012, China
| | - Zhi-lan Jiang
- Department of Radiation Oncology, Jilin Provincial Cancer Hospital, Changchun, 130012, China
| | - Wan-Ju Yang
- Department of Radiation Oncology, Jilin Provincial Cancer Hospital, Changchun, 130012, China
| | - Shi-xin Liu
- Department of Radiation Oncology, Jilin Provincial Cancer Hospital, Changchun, 130012, China
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Dong Y, Li Y, Liu R, Li Y, Zhang H, Liu H, Chen J. Secretagogin, a marker for neuroendocrine cells, is more sensitive and specific in large cell neuroendocrine carcinoma compared with the markers CD56, CgA, Syn and Napsin A. Oncol Lett 2020; 19:2223-2230. [PMID: 32194720 PMCID: PMC7039081 DOI: 10.3892/ol.2020.11336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/20/2019] [Indexed: 12/12/2022] Open
Abstract
A common method to distinguish large cell neuroendocrine carcinoma (LCNEC) from non-neuroendocrine large cell carcinoma (non-NE LCC) is from using specific immunohistochemistry markers, such as CgA, Syn, CD56 and Napsin A, however, the results remain controversial using these markers. Secretagogin (SCGN) is a newly discovered biomarker of neuroendocrine cells. In the present study, the expression of SCGN in 33 cases of human lung large cell carcinoma (LCC), including 17 cases of LCNEC and 16 cases of non-neuroendocrine (NE) LCC and lung cancer cell lines (A549, H1650, H358, H292 and H661). The association between SCGN expression and the clinicopathological characteristics of patients, including sex, age, clinical stage and metastasis, was analyzed. The results revealed that the different lung cancer cell lines had different expression levels of SCGN, and the SCGN protein was localized in the nucleus and cytoplasm of A549 cells detected using immunofluorescence. A total of 54.5% (18/33) of specimens positively expressed the SCGN protein. Of the 17 patients with LCNEC, only 23.5% (4/17) of cases were CgA positive, 35.29% (6/17) were Syn positive, 41.2% (7/17) were CD56 positive, and 41.2% (7/17) were Napsin A positive. However, SCGN was positively detected in 94.1% (16/17) of patients with LCNEC, which was more frequent compared with that in CgA, Syn, CD56 and Napsin A. Analysis of the clinical characteristics indicated that SCGN expression was only significantly associated with pathological type in patients with lung cancer (P<0.001). Furthermore, a positive correlation was observed between SCGN expression and CgA, Syn, and CD56 expression in patients with LCNEC. SCGN was co-localized with the NE markers (CgA, Syn, and CD56) in A549 lung cancer cells and in LCNEC tissues. Thus, SCGN displayed more sensitivity and specificity in lung cancer cells with NE differentiation. A combined analysis of SCGN and other common NE markers may be a potential tool for diagnosing these tumors.
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Affiliation(s)
- Yunlong Dong
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.,Department of Thoracic Surgery, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin 301800, P.R. China
| | - Yongwen Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Renwang Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Ying Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Hongbing Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Cao L, Zhao L, Wang M, Zhang XH, Yang ZC, Liu YP. Clinicopathological characteristics and prognosis of pulmonary large cell neuroendocrine carcinoma aged ≥65 years. PeerJ 2019; 7:e6824. [PMID: 31149394 PMCID: PMC6532618 DOI: 10.7717/peerj.6824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/21/2019] [Indexed: 12/18/2022] Open
Abstract
Objective The present study was designed to better characterize the clinicopathological features and prognosis in patients aged ≥65 years with pulmonary large cell neuroendocrine carcinoma (LCNEC). Methods Eligible patients with pulmonary LCNEC were retrieved from the Surveillance, Epidemiology, and End Results database between January 2004 and December 2013. The primary endpoints included cancer-specific survival (CSS) and overall survival (OS). Results Data of 1,619 eligible patients with pulmonary LCNEC were collected. These patients were subsequently categorized into two groups: 890 patients in the older group (age ≥65 years), and 729 in the younger group (age <65 years). More patients were of white ethnicity, stage I, married, and with tumor size <5 cm in the older group in comparison to the younger group. However, there were a significantly lower proportion of patients undergoing surgery, chemotherapy, and radiotherapy in the older group. The 5-year CSS rates of the younger group and older group were 23.94% and 17.94% (P = 0.00031), respectively, and the 5-year OS rates were 20.51% and 13.47% (P < 0.0001), respectively. Multivariate analyses indicated that older age (CSS: HR 1.20, 95% CI [1.07-1.36], P = 0.0024; OS: HR 1.26, 95% CI [1.12-1.41], P < 0.0001) was an independent risk factor for poor prognosis. The mortality risk of the elderly increased in almost every subgroup, especially in OS. Finally, significant predictors for better OS and CSS in patients over age 65 included tumor size <5 cm, lower stage, and receiving surgery, chemotherapy, or radiotherapy. Conclusion The prognosis of patients aged ≥65 years with pulmonary LCNEC was worse than that of younger patients. However, active and effective therapy could significantly improve the survival of older patients with pulmonary LCNEC.
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Affiliation(s)
- Ling Cao
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Ling Zhao
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Min Wang
- Department of Pathology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Xu He Zhang
- Department of Head and Neck Surgery, Cancer Hospital of Jilin Province, Changchun, China
| | - Zhu-Chun Yang
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Yun-Peng Liu
- Department of Thoracic Surgery, First Hospital of Jilin University, Changchun, Jilin, China
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9
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Cao L, Li ZW, Wang M, Zhang TT, Bao B, Liu YP. Clinicopathological characteristics, treatment and survival of pulmonary large cell neuroendocrine carcinoma: a SEER population-based study. PeerJ 2019; 7:e6539. [PMID: 30944773 PMCID: PMC6441320 DOI: 10.7717/peerj.6539] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/30/2019] [Indexed: 12/25/2022] Open
Abstract
Background This study was designed to investigate the clinicopathological characteristics, treatment and survival of patients with pulmonary large cell neuroendocrine carcinoma (LCNEC). Methods The Surveillance, Epidemiology and End Results database was utilized to identify patients diagnosed with pulmonary LCNEC between 2004 and 2013. Kaplan–Meier analysis was conducted to determine the overall survival (OS) and cancer-specific survival (CSS) rate. Univariate survival analysis along with log-rank test, and Cox proportional hazards model were employed to detect independent prognostic factors. Results Pulmonary LCNEC accounted for 0.58% (2972/510607) of the total number of lung and bronchus carcinoma. And a total of 1,530 eligible cases were identified, with the median follow-up time of 11 months. To be specific, the 3-, 5-year OS and CSS rates were 22.8%, 16.8% and 26.5%, 20.8% respectively. Generally, pulmonary LCNEC was commonly detected in the elderly (72.2%), males (55.9%), the upper lobe (62.0%) and advanced AJCC stage (65.5%). Multivariate analysis revealed that elderly [(≥60 and <80 years) HR:1.203, 95% CI [1.053–1.375], P = 0.007; (≥80 years) HR:1.530, 95% CI [1.238–1.891], P < 0.001] and advanced AJCC stage [(stage III) HR:2.606, 95% CI [2.083–3.260], P < 0.001; (stage IV) HR:4.881, 95% CI [3.923–6.072], P < 0.001] were independent unfavorable prognostic factors, and that female (HR:0.845, 95% CI [0.754–0.947], P = 0.004)), surgery [(Segmentectomy/wedge resection) HR:0.526, 95% CI [0.413–0.669], P < 0.001; (Lobectomy/Bilobectomy) HR:0.357, 95% CI [0.290–0.440], P < 0.001;(Pneumonectomy) HR:0.491, 95% CI [0.355–0.679], P < 0.001] , chemotherapy (HR:0.442, 95% CI [0.389–0.503], P < 0.001) and radiation (HR:0.837, 95% CI [0.738–0.949], P = 0.005) were independent favorable prognostic factors. Conclusion To sum up, age at diagnosis, sex, AJCC 8th edition stage, surgery, chemotherapy and radiation were significantly associated with OS of patients with pulmonary LCNEC.
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Affiliation(s)
- Ling Cao
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Zhi-Wen Li
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Min Wang
- Department of Pathology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Ting-Ting Zhang
- Department of Medical Oncology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Bo Bao
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Yun-Peng Liu
- Department of Thoracic Surgery, First Hospital of Jilin University, Changchun, Jilin, China
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Rajdev K, Siddiqui AH, Ibrahim U, Patibandla P, Khan T, El-Sayegh D. An Unusually Aggressive Large Cell Carcinoma of the Lung: Undiagnosed until Autopsy. Cureus 2018; 10:e2202. [PMID: 29682432 PMCID: PMC5908718 DOI: 10.7759/cureus.2202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Large cell carcinoma (LCC) of the lung has a rapid mean volume doubling time (VDT) of around 67-134 days. In some cases of LCC where the VDT is extremely rapid, clinical presentation may mimic acute lung pathologies such as pneumonia. We describe a rare presentation of an aggressive LCC of the lung with an estimated VDT of around two weeks. A 52-year-old male with a history schizophrenia presented with fever, cough, and dyspnea for three weeks duration. His medical history was significant for a recent admission six weeks before current presentation for myocardial infarction (MI) and pneumonia. Chest radiograph during the current admission showed a new right lung infiltrate and he was treated for healthcare-associated pneumonia. However, the patient developed acute respiratory failure due to right lung collapse requiring intubation and mechanical ventilation. An urgent bronchoscopy revealed an obstructing endobronchial mass in right mainstem bronchus. A computed tomography (CT) scan of the chest showed encasement of right upper and lower lobe bronchus with extensive mediastinal lymphadenopathy. The patient expired within the next 24 hours. The autopsy showed undifferentiated LCC of lung metastatic to the regional lymph nodes. Of note is the fact that the patient had CT chest in his prior admission which showed no signs of lung or mediastinal mass. We report a case of LCC which manifested as pneumonia over a six-week period with a calculated doubling time of 14.1 days. Oxidative stress secondary to recent MI and schizophrenia may have a role in the unusual aggressiveness in this case.
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Affiliation(s)
- Kartikeya Rajdev
- Internal Medicine, Northwell Health-Staten Island University Hospital, New York
| | | | - Uroosa Ibrahim
- Department of Hematology and Oncology, Staten Island University Hospital
| | - Prateek Patibandla
- Internal Medicine, Northwell Health-Staten Island University Hospital, New York
| | - Tahir Khan
- Internal Medicine, Northwell Health-Staten Island University Hospital, New York
| | - Dany El-Sayegh
- Pulmonary and Critical Care Medicine, Staten Island University Hospital
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Bi Y, Qu Y, Liang Z, Liu Z, Zhang H, Liang X, Luo Y, Cao J, Zhang H, Feng R. Clinicopathological analysis of Large Cell Lung Carcinomas definitely diagnosed according to the New World Health Organization Criteria. Pathol Res Pract 2018. [PMID: 29525405 DOI: 10.1016/j.prp.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The definition of large cell lung carcinoma (LCC) has undergone an extensive modification in the World Health Organization (WHO) Classification (2015). Present study aimed to investigate the clinicopathological characteristics of patients diagnosed as LCC according to current WHO criteria. METHODS LCCs diagnosed based on the previous WHO classification were reevaluated, and 17 cases of LCC were finally identified at Peking Union Medical College Hospital and Beijing Chest Hospital between 2009 and 2015. The clinicopathologic features were examined and EGFR and KRAS mutations were tested. Survival of the patients was analyzed by Kaplan-Meier method. RESULTS The median age of the patients was 64 years (range: 40-78). Most patients were male (64.7%) and about half of the patients were at TNM stage III (47.1%). Morphologically, most cases (70.6%) were classic LCC. All patients were treated by lobectomy plus lymph node dissection, 2 with bi-lobectomy and 1 with complex lobectomy, and the other 2 patients were further treated by partial pericardiotomy. Ten patients received postoperative chemotherapy, while only 3 patients were treated with radiotherapy after surgery. Molecular analysis showed two cases of EGFR mutation (L858R) but without non-overlapping KRAS mutation. The 3-year overall survival rate was 48.4 ± 15.1%. Chemotherapy was the only predictive factor that is associated with the prognosis of the patients (P = 0.003). CONCLUSION The clinicopathological characteristics of 17 cases of stringently diagnosed LCC were retrospectively analyzed. LCC in our study showed aggressive behavior with high recurrence and metastasis and poor prognosis. Chemotherapy was only predictive factor that is significantly associated with the prognosis of the patients. Future studies based on a larger series and long term follow-up are still needed to characterize it further.
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Affiliation(s)
- Yalan Bi
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yang Qu
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zichen Liu
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Hui Zhang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaolong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yufeng Luo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jinling Cao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Haiqing Zhang
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.
| | - Ruie Feng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Xie C, Xu X, Wu B, Yang KY, Huang J. Primary pulmonary lymphoepithelioma-like carcinoma in non-endemic region: A case report and literature review. Medicine (Baltimore) 2018; 97:e9976. [PMID: 29465599 PMCID: PMC5841981 DOI: 10.1097/md.0000000000009976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare type of lung squamous cell carcinoma. In situ hybridization test for Epstein-Bar virus-encoded RNA (EBER) is generally used for distinguishing it from other lung cancers. Although plasma EBV DNA quantification has been widely used as a tumor biomarker in nasopharyngeal carcinoma (NPC), only a limiting number of studies have suggested that plasma EBV DNA quantification may be used as a tumor marker in pulmonary LELC patients. PATIENT CONCERNS We report two female patients diagnosed as poorly differentiated squamous cell carcinoma, subsequently, their further histological examinations showed that tumor cells were EBER positive and plasma EBV DNA was detectable. DIAGNOSES Two patients was diagnosed with advanced pulmonary LELC. INTERVENTIONS The patients were treated with chemotherapy and chemoradiotherapy respectively. OUTCOMES Both patients responded well to our treatment, in accordance with their decreased EBV DNA level. LESSONS Pulmonary LELC is a rare type of lung cancer which is sensitive to chemoradiotherapy, especially in late staged patients.
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Affiliation(s)
| | - Xia Xu
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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13
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Xu X, Cui Y, Cao L, Zhang Y, Yin Y, Hu X. PCSK9 regulates apoptosis in human lung adenocarcinoma A549 cells via endoplasmic reticulum stress and mitochondrial signaling pathways. Exp Ther Med 2017; 13:1993-1999. [PMID: 28565798 DOI: 10.3892/etm.2017.4218] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/09/2016] [Indexed: 12/27/2022] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a member of the subtilisin family of PCs that encodes a neural apoptosis-regulated convertase 1. However, the precise role of PCSK9 in lung cancer cell apoptosis has remained elusive. In the present study, A549 human lung adenocarcinoma cells were transfected with PCSK9 small interfering (si)RNA to investigate the underlying mechanisms of apoptosis. The results indicated that PCSK9 siRNA exhibited anti-tumor activity by inducing apoptosis as determined by a Cell Counting Kit-8 and Hoechst staining analysis. In addition, PCSK9 siRNA significantly increased apoptosis of A549 cells in part via activation of caspase-3 and downregulation of the anti-apoptotic proteins survivin and X-linked inhibitor of apoptosis protein. Moreover, the results demonstrated that perturbations in the mitochondrial membrane were associated with the deregulation of the Bax/Bcl-2 ratio, which led to the release of cytochrome c after PCSK9 siRNA transfection. In addition, PCSK9 siRNA also induced endoplasmic reticulum stress (ERS) by increasing the levels of 78 kDa glucose-regulated protein (GRP78), GRP94, phosphorylated protein kinase R-like ER kinase and phosphorylated eukaryotic initiation factor 2α. Therefore, these results demonstrated that PCSK9 siRNA may exert its anti-tumor activity through inducing mitochondrial dysfunction and ERS-associated cell death in A549 cells.
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Affiliation(s)
- Xiaohui Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Yushang Cui
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Lei Cao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Ye Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Yan Yin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Xue Hu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100730, P.R. China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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14
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Jiang WY, Wang R, Pan XF, Shen YZ, Chen TX, Yang YH, Shao JC, Zhu L, Han BH, Yang J, Zhao H. Clinicopathological features and prognosis of primary pulmonary lymphoepithelioma-like carcinoma. J Thorac Dis 2016; 8:2610-2616. [PMID: 27747015 DOI: 10.21037/jtd.2016.08.40] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Lymphoepithelioma-like carcinoma (LELC) is a rare form of non-small cell lung carcinoma. The current study focused on its clinicopathological features and potential factors influencing the prognosis. METHODS The statistical analysis was based on the clinicopathological records and the prognosis of 43 LELC patients, analyzed by Kaplan-Meier method, Log-rank test, and COX regression analysis. RESULTS The patients' average age was 57.35±9.22 years, 86.05% of them were non-smokers and 53.49% were women. The average tumor diameter was 3.24±1.57 cm. The 2- and 5-year overall survival (OS) rates of LELC patients were 90% and 74%, respectively; the disease-free survival (DFS) rates were 87% and 47%, respectively. The patients with large tumor, accompanied with lymph nodes metastasis or at the advanced stage had the worst OS, and the patients with lymph nodes metastasis or at the advanced stage had the worst DFS. Univariate analysis indicated that T and N grading and TNM stage influenced the OS, and N grading and TNM stage influenced the DFS; the independent factors affecting OS or DFS were not identified by multivariate analysis. CONCLUSIONS LELC commonly occurred in senior non-smoking women. In summary, the prognosis of LELC was satisfactory.
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Affiliation(s)
- Wen-Yang Jiang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China;; Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xu-Feng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yu-Zhou Shen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Tian-Xiang Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yun-Hai Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jin-Cheng Shao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Bao-Hui Han
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jun Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Abstract
Lung neuroendocrine tumors are a heterogeneous subtype of pulmonary cancers representing approximately 20% of all lung cancers, including small-cell lung cancer (SCLC) and large-cell neuroendocrine carcinoma (LCNEC). The frequency appears to be approximately 3% for LCNEC. Diagnosis of LCNEC requires attention to neuroendocrine features by light microscopy and confirmation by immunohistochemical staining for neuroendocrine markers. Both SCLC and pulmonary LCNEC are high-grade and poor-prognosis tumors, with higher incidence in males and smokers and peripheral localization. LCNEC is very rare, and the precise diagnosis on small specimens is very difficult, so we have still too few data to define a standard of treatment for pulmonary LCNECs. Data of literature, most based on retrospective analysis, indicated a poor 5-year overall survival, with a high incidence of recurrence after surgery, even in stage I disease. Primary surgery should be the first option in all operable patients because there is no validate therapeutic approach for LCNEC due to lack of clinical trials in this setting. Neoadjuvant platinum-based regimens remain only an option for potentially resectable tumors. In advanced stages, SCLC-like chemotherapy seems the best option of treatment, with a good response rate but a poor overall survival (from 8 to 16 months in different case series). New agents are under clinical investigation to improve LCNEC patients' outcome. We reviewed all data on treatment options feasible for pulmonary LCNEC, both for localized and extensive disease.
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Lo Russo G, Pusceddu S, Proto C, Macerelli M, Signorelli D, Vitali M, Ganzinelli M, Gallucci R, Zilembo N, Platania M, Buzzoni R, de Braud F, Garassino MC. Treatment of lung large cell neuroendocrine carcinoma. Tumour Biol 2016; 37:7047-57. [DOI: 10.1007/s13277-016-5003-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/25/2016] [Indexed: 12/23/2022] Open
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İNCEKARA F, AYDOĞDU K, SAYILIR E, GÜLHAN SŞE, DEMİRAĞ F, KAYA S, FINDIK G. Surgical management of large-cell neuroendocrinelung carcinoma: an analysis of 25 cases. Turk J Med Sci 2016; 46:1808-1815. [DOI: 10.3906/sag-1507-115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 03/26/2016] [Indexed: 11/03/2022] Open
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