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Defining the role of adjuvant therapy for early-stage large cell neuroendocrine carcinoma

Published:September 30, 2019DOI:https://doi.org/10.1016/j.jtcvs.2019.09.077

      Abstract

      Introduction

      Large cell neuroendocrine carcinoma is a rare, high-grade neuroendocrine tumor. The mainstay of treatment for early, node-negative disease is surgical resection, and optimal adjuvant treatment strategies are not well defined.

      Methods

      Patients with early, node-negative large cell neuroendocrine carcinoma were identified in the National Cancer Database from 2004 to 2014. Patient, tumor, treatment, and hospital characteristics were examined. Survival differences in patients receiving adjuvant chemotherapy (AC) were evaluated using Kaplan-Meier curves, and adjusted multivariate Cox models were constructed. A conditional landmark analysis was used to address immortal time bias. T-stage-specific propensity score matching was used to address covariate imbalances between groups.

      Results

      One thousand seven hundred seventy patients were identified, of whom 463 (26.2%) received AC. Patients receiving AC were younger, less comorbid, and more likely to have T2 tumors. AC was associated with significantly longer survival, which persisted after adjustment in Cox models, for patients overall (5-year overall survival, 59.2% vs 45.3%; hazard ratio, 0.69; 95% confidence interval, 0.58-0.82; P < .0001), T2 tumors (overall survival, 59.8% vs 42.1%; hazard ratio, 0.63; 95% confidence interval, 0.50-0.81; P < .0001), and tumors 2 to 3 cm (overall survival, 60.0% vs 42.6%; hazard ratio, 0.64; 95% confidence interval, 0.46-0.8; P = .002), but not tumors smaller than 2 cm. Adjuvant chest radiotherapy was not associated with longer survival. Sublobar resection was associated with worse overall survival compared with lobectomy (hazard ratio, 1.40; 95% confidence interval, 1.20-1.64; P < .0001). Propensity score matching confirmed these findings, but the association with survival for tumors 2 to 3 cm in size was not significant.

      Conclusions

      In this national study of early-stage large cell neuroendocrine carcinoma, AC was associated with significantly longer survival for tumors larger than 3 cm, and possibly for tumors 2 to 3 cm. Adjuvant radiation was not associated with prolonged survival.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      LCNEC (large cell neuroendocrine carcinoma), LOS (length of stay), NCDB (National Cancer Database), NSCLC (non–small cell lung cancer), OS (overall survival), SCLC (small cell lung cancer)
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      Linked Article

      • Commentary: Chemotherapy for stage IB large cell neuroendocrine carcinomas of lung: Convention becomes conviction
        The Journal of Thoracic and Cardiovascular SurgeryVol. 159Issue 5
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          Thoracic oncologists and surgeons have long recognized that large cell neuroendocrine carcinomas (LCNECs) represent a more aggressive type of non–small cell lung cancer. Meanwhile, LCNECs are relatively resistant to cisplatin-based chemotherapy compared with small cell carcinoma.1 Because LCNECs are rare, prospective evidence of the benefit of chemotherapy is lacking, especially for early-stage disease. Furthermore, there is compelling evidence that cisplatin-based chemotherapy is harmful for all patients with stage IA non–small cell lung cancer and of little benefit for those with tumors up to 4 cm in size.
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