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Different Characteristics and Survival between Surgically Resected Pure and Combined Pulmonary Large Cell Neuroendocrine Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Large cell neuroendocrine carcinoma (LCNEC) is a rare high-grade neuroendocrine carcinoma of the lung. Little is known about the differences between the pure and combined LCNEC subtypes, and thus we conducted this study to provide more comprehensive insight into LCNEC.

Methods

We reviewed 221 patients with pure LCNEC (P-LCNEC) and 120 patients with combined LCNEC (C-LCNEC) who underwent pulmonary surgery in our hospital to compare their clinical features, driven genes’ status (EGFR/ALK/ROS1/KRAS/BRAF), and adjuvant chemotherapy regimens. Propensity score matching (PSM) was applied to reduce selection bias.

Results

The P-LCNEC group included a higher proportion of males and smokers than the C-LCNEC group. Furthermore, the C-LCNEC group had higher incidences of visceral pleural invasion (VPI), EGFR mutation and ALK rearrangement compared with the P-LCNEC group. Expression of neuroendocrine markers (CD56, CGA, and SYN) and recurrence patterns were not significantly different between the two groups. The P-LCNEC group had better disease-free survival (DFS) and overall survival (OS) compared with the C-LCNEC group (median DFS: 67.0 vs. 28.1 months, p = 0.021; median OS: 72.0 vs. 45.0 months, p = 0.001), which was further confirmed by the PSM method (p = 0.004 and p < 0.001, respectively). Adjuvant chemotherapy was also an independent factor for DFS and OS. Subgroup analysis found that regardless of whether it was for the entire LCNEC group or the P- and C-LCNEC subtypes, the small cell lung cancer (SCLC) regimens presented with superior survival compared with the non-small cell lung cancer (NSCLC) regimens.

Conclusion

P-LCNEC was associated with more favorable prognosis compared with C-LCNEC. SCLC-based adjuvant chemotherapy was more appropriate for LCNEC patients than NSCLC-based regimens, regardless of whether they were the pure or combined LCNEC subtypes. C-LCNEC patients may be the potential beneficiary of targeted therapy.

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Acknowledgment

The authors thank the study participants for their contribution to this research.

Funding

This research was supported by the Science and Technology Commission of Shanghai Municipality Project (Project No. 16140902700) and the foundation of Shanghai Shenkang Hospital Development Center Emerging Frontier Technology Joint Research Project (Project No. SHDC12015115).

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Author notes

  1. Yanan Wang, Ya Chen, and Zhengyu Yang have contributed equally to this work.

Authors and Affiliations

  1. Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

    Yanan Wang MD, Ya Chen MD, Zhengyu Yang MD, Fangfei Qian MD, Minjuan Hu MD, Jun Lu MD, Yanwei Zhang MD, Wei Zhang MD & Baohui Han MD, PhD

  2. Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

    Kai Wang MD

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  1. Yanan Wang MD
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Contributions

Yanan Wang, Ya Chen, and Zhengyu Yang made substantial contributions to the conception or design of this work, collection and analysis of data, and writing and editing the article. Fangfei Qian, Minjuan Hu, Jun Lu, Yanwei Zhang, Wei Zhang, Kai Wang, and Baohui Han made substantial contributions to this work by providing editing and writing assistance.

Corresponding authors

Correspondence to Kai Wang MD or Baohui Han MD, PhD.

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Disclosure

Yanan Wang, Ya Chen, Zhengyu Yang, Fangfei Qian, Minjuan Hu, Jun Lu, Yanwei Zhang, Wei Zhang, Kai Wang, and Baohui Han have no conflicts of interest to declare.

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Wang, Y., Chen, Y., Yang, Z. et al. Different Characteristics and Survival between Surgically Resected Pure and Combined Pulmonary Large Cell Neuroendocrine Carcinoma. Ann Surg Oncol 29, 5666–5678 (2022). https://doi.org/10.1245/s10434-022-11610-4

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