Clinicopathological characteristics and prognostic factors of pulmonary large cell neuroendocrine carcinoma: A large population‐based analysis

Abstract

Background The study was conducted to compare the clinicopathological characteristics, survival outcomes, and metastatic patterns between pulmonary large cell neuroendocrine carcinoma (LCNEC) and other non‐small cell lung cancer (ONSCLC), and to identify the prognostic factors of LCNEC. Methods Data of patients diagnosed with LCNEC and ONSCLC from 2004 to 2014 were obtained from the Surveillance, Epidemiology, and End Results dataset. Pearson’s chi‐square tests were used to compare differences in clinicopathological characteristics. The Kaplan–Meier method was used for survival analysis. A propensity score was used for matching and a Cox proportional hazards model was used for multivariate and subgroup analyses. Results A total of 2368 LCNEC cases and 231 672 ONSCLC cases were identified. LCNEC incidence increased slightly over time. Except for marital status, LCNEC patients had obviously different biological features to ONSCLC patients. Survival analysis showed that LCNEC had poorer outcomes than ONSCLC. Multivariate analysis revealed that female gender, black race, surgery, radiation, and chemotherapy were protective factors for LCNEC. Matched subgroup analysis further demonstrated that most subgroup factors favored ONSCLC, especially in early stage. Early‐stage LCNEC patients had a higher risk of lung cancer‐specific death than early‐stage ONSCLC patients. Moreover, metastatic patterns were different between LCNEC and ONSCLC. LCNEC patients with isolated liver metastasis or combined invasion to other organs had poorer survival rates. Conclusions LCNEC has totally different clinicopathological characteristics and metastatic patterns to ONSCLC. LCNEC also has poorer survival outcomes, primarily because of isolated liver metastasis or combined invasion to other organs. Most subgroup factors are adverse factors for LCNEC.

Prognostic factors of patients with pulmonary large-cell neuroendocrine carcinoma after surgery: a competing risk analysis

“…Cattoni et al [9] analyzed 101 patients with pulmonary LCNEC who underwent lung resection, and the results showed that the higher the T stage, the worse the prognosis, and there was no statistical signi cance between N stage and survival rate. A recent study analyzed the metastasis pattern of pulmonary LCNEC and found that lymph node metastasis and distant metastasis were adverse factors for survival [14]. Our results also showed a similar phenomenon.…”

“…Traditional survival analysis methods such as Kaplan-Meier method and Cox model may had limitations because they ignored the competing risk factors between outcome events [10]. In the previous survival analysis of LCNEC, competing risk events were treated as censored, which may lead to the risk of bias [11].Moreover, a large-sample study of rare diseases can be conducted by utilizing a population-based cancer database, and the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute covers approximately 34.6% of the U.S. population [12][13][14]. Analysis of the SEER database should provide useful information about prognostic factors in patients with pulmonary LCNEC after surgery.…”

Analysis of systemic inflammatory biomarkers in neuroendocrine carcinomas of the lung: prognostic and predictive significance of NLR, LDH, ALI, and LIPI score

“…Gender, extent of disease, ECOG PS, hemoglobin, LDH, NSE and chemotherapy disease control are well-recognized prognostic factors for SCLC and LCNEC. 14 – 20 …”

Prognostic factors for pulmonary large-cell neuroendocrine carcinoma: a competing-risks analysis

“…A series of previous reports showed that pulmonary LCNEC patients are mainly male, elderly, and heavy smokers, with at least half of these patients having a history of smoking [18][19][20][21]. Similarly, recent analyses based on the SEER database have led to consistent conclusions [22][23][24]. In short, the survival outcomes of LCNEC differ between men and women, but confirming whether this difference is related to smoking requires further research.…”