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Abstract：
Background: In 2015, large cell neuroendocrine carcinoma (LCNEC) was removed from the large cell carcinoma group and classified with small cell lung carcinoma (SCLC) constituting two members of the high-grade neuroendocrine tumors (NETs) of the lung. However, the difference between high-grade LCNEC and SCLC in terms of clinicopathological characteristics and prognosis has not been fully understood owing to the rarity of LCNEC. Patients and methods: Patients with high-grade LCNEC and SCLC at initial diagnosis between 2001 and 2014 were identified using the Surveillance, Epidemiology, and End Results (SEER) program database. Clinicopathological characteristics between high-grade LCNEC and SCLC were compared using the Pearson\'s chi-squared test or Fisher\'s exact test. Differences in overall survival (OS) and cancer-specific survival (CSS) were compared using the log-rank test, Cox models and propensity score matching (PSM) analysis. Results: A total of 1223 patients with high-grade LCNEC and 18182 patients with high-grade SCLC were enrolled. To the best of our knowledge, this study involved the largest number of high-grade LCNEC patients to date, with respect to a comparison between high-grade LCNEC and high-grade SCLC patients. There were significant differences in age, sex, race, laterality, SEER stage, nodal status, surgery, radiation and chemotherapy, but not marital status, between high-grade LCNEC and SCLC patients. High-grade LCNEC patients had a better OS and CSS than high-grade SCLC patients. Subgroup analysis also confirmed the better prognosis of the high-grade LCNEC patients in the regional stage, distant stage and surgery subgroups. However, no significant difference in prognosis was observed between the two non-surgery subgroups, which was confirmed using PSM analysis. Furthermore, high-grade LCNEC patients showed different metastatic patterns to high-grade SCLC patients. Conclusion: These results suggested that high-grade LCNEC and high-grade SCLC were different histological types, and that a detailed classification for high-grade NETs of the lung was needed.
摘要：
背景：2015年，大细胞神经内分泌癌（LCNEC）从大细胞癌组中移除，并与小细胞肺癌（SCLC）分类，构成肺高级别神经内分泌肿瘤（NETs）的两个成员。然而,由于LCNEC的罕见性,高级别LCNEC和SCLC在临床病理特征和预后方面的差异尚未完全了解.患者和方法：2001年至2014年初始诊断为高级别LCNEC和SCLC的患者使用监测进行鉴定。流行病学,和结束结果(SEER)程序数据库。使用Pearson卡方检验或Fisher精确检验比较高级别LCNEC和SCLC的临床病理特征。使用对数秩检验比较总生存期（OS）和癌症特异性生存期（CSS）的差异，Cox模型和倾向得分匹配(PSM)分析。结果：共纳入1223例高级别LCNEC患者和18182例高级别SCLC患者。据我们所知,这项研究涉及迄今为止最多的高级别LCNEC患者，关于高级别LCNEC和高级别SCLC患者之间的比较。年龄差异显著,性别,种族,偏侧性,SEER阶段,节点状态，手术,放疗和化疗,但不是婚姻状况,高级别LCNEC和SCLC患者之间。高级别LCNEC患者的OS和CSS优于高级别SCLC患者。亚组分析也证实高级别LCNEC患者在区域阶段的预后较好，远端阶段和手术亚组。然而,两个非手术亚组之间的预后没有显着差异，使用PSM分析证实了这一点。此外，高级别LCNEC患者与高级别SCLC患者的转移模式不同.结论：这些结果提示高级别LCNEC和高级别SCLC是不同的组织学类型，并且需要对肺部的高级NETs进行详细分类。
