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Abstract：
The 2015 World Health Organization classification defines pulmonary large-cell neuroendocrine carcinoma (LCNEC) as a high-grade neuroendocrine carcinoma. However, the clinical characteristics and prognostic factors of pure LCNEC and combined LCNEC remain unclear. Hence, we performed a multi-center retrospective study to compare the clinical outcomes of pure versus combined LCNEC.
Data from 381 patients with pulmonary LCNEC admitted to 17 Chinese institutes between 2009 and 2016 were collected retrospectively. Clinical characteristics and prognosis were analyzed among patients receiving adjuvant (adjuvant group; n = 56) and first-line (first-line group; n = 146) chemotherapy, as well as among patients receiving small cell lung cancer (SCLC) and non-SCLC (NSCLC) chemotherapy regimens. The Kaplan-Meier method and multivariable Cox regression were used to identify clinicopathological variables that might influence patient outcomes.
Expression levels of neuroendocrine markers (synaptophysin, chromogranin-A, CD56) were associated with patients\' prognosis in the total study cohort. In the adjuvant group, median disease-free survival was non-significantly longer for SCLC-based regimens than for NSCLC-based regimens (P = 0.112). In the first-line group, median progression-free survival was significantly longer for SCLC-based regimens than for NSCLC-based regimens (11.5 vs. 7.2 months, P = 0.003). Among patients with combined LCNEC, adenocarcinoma was the most common combined component, accounting for 70.0 % of cases. Additionally, median overall survival was non-significantly shorter for combined LCNEC than for pure LCNEC (P = 0.083).
The SCLC regimen is a more effective choice, as either first-line or adjuvant chemotherapy, when compared to the NSCLC regimen for LCNEC treatment. Further studies are needed to clarify the survival differences between patients with pure-, and combined LCNEC.
Data from 381 patients with pulmonary LCNEC admitted to 17 Chinese institutes between 2009 and 2016 were collected retrospectively. Clinical characteristics and prognosis were analyzed among patients receiving adjuvant (adjuvant group; n = 56) and first-line (first-line group; n = 146) chemotherapy, as well as among patients receiving small cell lung cancer (SCLC) and non-SCLC (NSCLC) chemotherapy regimens. The Kaplan-Meier method and multivariable Cox regression were used to identify clinicopathological variables that might influence patient outcomes.
Expression levels of neuroendocrine markers (synaptophysin, chromogranin-A, CD56) were associated with patients\' prognosis in the total study cohort. In the adjuvant group, median disease-free survival was non-significantly longer for SCLC-based regimens than for NSCLC-based regimens (P = 0.112). In the first-line group, median progression-free survival was significantly longer for SCLC-based regimens than for NSCLC-based regimens (11.5 vs. 7.2 months, P = 0.003). Among patients with combined LCNEC, adenocarcinoma was the most common combined component, accounting for 70.0 % of cases. Additionally, median overall survival was non-significantly shorter for combined LCNEC than for pure LCNEC (P = 0.083).
The SCLC regimen is a more effective choice, as either first-line or adjuvant chemotherapy, when compared to the NSCLC regimen for LCNEC treatment. Further studies are needed to clarify the survival differences between patients with pure-, and combined LCNEC.
摘要：
2015年世界卫生组织分类将肺大细胞神经内分泌癌（LCNEC）定义为高级神经内分泌癌。然而,单纯LCNEC和联合LCNEC的临床特征和预后因素尚不清楚.因此，我们进行了一项多中心回顾性研究,以比较纯LCNEC与联合LCNEC的临床结局.
回顾性收集了2009年至2016年间17家中国机构收治的381例LCNEC患者的数据。分析接受辅助（辅助组；n=56）和一线（一线组；n=146）化疗的患者的临床特征和预后。以及接受小细胞肺癌（SCLC）和非SCLC（NSCLC）化疗方案的患者。使用Kaplan-Meier方法和多变量Cox回归来确定可能影响患者预后的临床病理变量。
神经内分泌标志物的表达水平（突触素，嗜铬粒蛋白A,在整个研究队列中，CD56）与患者预后相关。在佐剂组中，以SCLC为基础的方案的中位无病生存期长于以NSCLC为基础的方案(P=0.112).在一线组中，以SCLC为基础的方案的中位无进展生存期明显长于以NSCLC为基础的方案（11.5vs.7.2个月,P=0.003)。在合并LCNEC的患者中，腺癌是最常见的合并成分，占病例的70.0%。此外,联合LCNEC的中位总生存期短于纯LCNEC(P=0.083).
SCLC方案是更有效的选择，作为一线或辅助化疗，与LCNEC治疗的NSCLC方案相比。需要进一步的研究来澄清患者之间的生存差异。合并LCNEC。
回顾性收集了2009年至2016年间17家中国机构收治的381例LCNEC患者的数据。分析接受辅助（辅助组；n=56）和一线（一线组；n=146）化疗的患者的临床特征和预后。以及接受小细胞肺癌（SCLC）和非SCLC（NSCLC）化疗方案的患者。使用Kaplan-Meier方法和多变量Cox回归来确定可能影响患者预后的临床病理变量。
神经内分泌标志物的表达水平（突触素，嗜铬粒蛋白A,在整个研究队列中，CD56）与患者预后相关。在佐剂组中，以SCLC为基础的方案的中位无病生存期长于以NSCLC为基础的方案(P=0.112).在一线组中，以SCLC为基础的方案的中位无进展生存期明显长于以NSCLC为基础的方案（11.5vs.7.2个月,P=0.003)。在合并LCNEC的患者中，腺癌是最常见的合并成分，占病例的70.0%。此外,联合LCNEC的中位总生存期短于纯LCNEC(P=0.083).
SCLC方案是更有效的选择，作为一线或辅助化疗，与LCNEC治疗的NSCLC方案相比。需要进一步的研究来澄清患者之间的生存差异。合并LCNEC。
