Abstract：
BACKGROUND: Pulmonary large cell neuroendocrine carcinoma (LCNEC) represents an exceptionally aggressive and infrequent variant within the realm of non-small cell lung cancer, necessitating surgical intervention as the primary therapeutic approach. However, the postoperative management strategy for early-stage patients continues to be a subject of intense debate and uncertainty.
METHODS: A retrospective analysis was conducted on a cohort of patients diagnosed with LCNEC who underwent surgical resection at Shanghai Pulmonary Hospital between July 2018 and June 2022. Comprehensive assessments, encompassing univariate and multivariate analyses, were performed to evaluate the prognostic significance of these indicators in patient clinical profiles, overall survival (OS), and disease-free survival (DFS).
RESULTS: A comprehensive screening effort identified 171 patients with LCNEC, with 70 stage I patients meeting the criteria for inclusion in the final cohort. Of these, 11 patients (15.7%) presented with combined LCNEC, and 59 (84.3%) exhibited pure LCNEC. Univariate and multivariate analyses both unveiled that spread through air spaces (STAS) status emerged as an independent prognostic determinant for both DFS (P = .003) and OS (P = .013), whereas histologic subtype independently predicted OS (P = .011). Subgroup survival analyses further underscored that the advantageous effects of postoperative chemotherapy were significantly pronounced exclusively among STAS-positive patients, showcasing a statistically significant enhancement in DFS (P = .047) and OS (P = .018).
CONCLUSIONS: STAS may serve as an adverse prognostic factor in stage I LCNEC patients, potentially offering guidance for postoperative chemotherapy decisions.
METHODS: A retrospective analysis was conducted on a cohort of patients diagnosed with LCNEC who underwent surgical resection at Shanghai Pulmonary Hospital between July 2018 and June 2022. Comprehensive assessments, encompassing univariate and multivariate analyses, were performed to evaluate the prognostic significance of these indicators in patient clinical profiles, overall survival (OS), and disease-free survival (DFS).
RESULTS: A comprehensive screening effort identified 171 patients with LCNEC, with 70 stage I patients meeting the criteria for inclusion in the final cohort. Of these, 11 patients (15.7%) presented with combined LCNEC, and 59 (84.3%) exhibited pure LCNEC. Univariate and multivariate analyses both unveiled that spread through air spaces (STAS) status emerged as an independent prognostic determinant for both DFS (P = .003) and OS (P = .013), whereas histologic subtype independently predicted OS (P = .011). Subgroup survival analyses further underscored that the advantageous effects of postoperative chemotherapy were significantly pronounced exclusively among STAS-positive patients, showcasing a statistically significant enhancement in DFS (P = .047) and OS (P = .018).
CONCLUSIONS: STAS may serve as an adverse prognostic factor in stage I LCNEC patients, potentially offering guidance for postoperative chemotherapy decisions.
摘要：
背景：肺大细胞神经内分泌癌（LCNEC）代表了非小细胞肺癌领域中异常侵袭性和罕见的变异，需要手术干预作为主要的治疗方法。然而,早期患者的术后管理策略仍然是一个激烈争论和不确定性的话题.
方法：对2018年7月至2022年6月在上海市肺科医院接受手术切除的LCNEC患者进行了回顾性分析。全面评估，包括单变量和多变量分析，进行评估这些指标在患者临床资料方面的预后意义，操作系统,和DFS。
结果：一项全面的筛查工作确定了总共171名LCNEC患者，70例I期患者符合纳入最终队列的标准。11例患者（15.7%）出现联合LCNEC，59例患者（84.3%）表现为纯LCNEC。单变量和多变量分析都揭示了通过空气空间传播（STAS）状态成为DFS和总体OS的独立预后决定因素（分别为p=0.003，p=0.013），而组织学亚型独立预测OS（p=0.011）。亚组生存分析进一步强调，术后化疗的有利效果仅在STAS阳性患者中显著显著。显示DFS和OS的统计学显着提高（分别为p=0.047和p=0.018）。
结论：STAS可能是I期LCNEC患者的不良预后因素，可能为术后化疗决策提供指导。
方法：对2018年7月至2022年6月在上海市肺科医院接受手术切除的LCNEC患者进行了回顾性分析。全面评估，包括单变量和多变量分析，进行评估这些指标在患者临床资料方面的预后意义，操作系统,和DFS。
结果：一项全面的筛查工作确定了总共171名LCNEC患者，70例I期患者符合纳入最终队列的标准。11例患者（15.7%）出现联合LCNEC，59例患者（84.3%）表现为纯LCNEC。单变量和多变量分析都揭示了通过空气空间传播（STAS）状态成为DFS和总体OS的独立预后决定因素（分别为p=0.003，p=0.013），而组织学亚型独立预测OS（p=0.011）。亚组生存分析进一步强调，术后化疗的有利效果仅在STAS阳性患者中显著显著。显示DFS和OS的统计学显着提高（分别为p=0.047和p=0.018）。
结论：STAS可能是I期LCNEC患者的不良预后因素，可能为术后化疗决策提供指导。
