■大细胞神经内分泌肺癌(LCNEC)是一种罕见的肺肿瘤,预后差,治疗选择有限。
■我们回顾性分析了自2010年以来德国大型学术中心记录的所有转移性LCNEC患者。
■191名患者被确定为男性(68%)吸烟者(92%),中位年龄为65岁。与结果相关的最重要的因素是全身治疗的类型,在使用免疫检查点抑制剂的情况下,中位总生存期(OS)为26.4个月(n=13),其他接受一线铂双抗体的患者9.0个月(n=129),非铂化疗4.0个月(n=17,p<0.01)。与较长OS独立相关的其他患者特征是较低的基线血清LDH(风险比[HR]0.54,p=0.008)和较少的初始转移部位(HR0.52,p=0.006)。而铂类药物类型(顺铂与卡铂)和细胞毒性伴侣(依托泊苷vs.紫杉醇),患者吸烟状况和肿瘤标志物基线水平(NSE,CYFRA21-1,CEA)无关紧要。12%(23/191)的患者放弃了全身治疗,主要是由于肿瘤相关的临床恶化(n=13),而患者拒绝治疗(n=5)和严重合并疾病(n=5)的频率较低。连续处理线之间的磨耗约为50%,铂基与铂基相似。其他疗法,但在初始ECOG状态较差或血清LDH较高的情况下较高(p<0.05)。19%(36/191)的患者患有继发性IV期疾病,转移部位较少,更好的ECOG状态和更长的OS(中位数12.6vs.8.7个月,p=0.030)。在111例接受姑息性全身治疗和完整随访的死亡患者中,排除寡转移病例后(n=8),局部治疗(n=63或57%)与较长的OS(HR0.58,p=0.008)相关,但这种关联在多变量检验中并不存在.
■高度活跃的全身疗法,特别是免疫疗法和铂双分子,对于改善LCNEC的结果至关重要,并且影响OS比临床疾病参数更强,实验室结果和其他患者特征。化疗线之间的损耗约为50%,与其他NSCLC相似。继发性转移性疾病患者具有更有利的临床表型和更长的生存期。
BACKGROUND: Large-cell neuroendocrine lung carcinoma (LCNEC) is a rare pulmonary neoplasm with poor prognosis and limited therapeutic options.
METHODS: We retrospectively analyzed all patients with metastatic LCNEC in the records of a large German academic center since 2010.
RESULTS: 191 patients were identified with a predominance of male (68%) smokers (92%) and a median age of 65 years. The single most important factor associated with outcome was the type of systemic treatment, with a median overall survival (OS) of 26.4 months in case of immune checkpoint inhibitor administration (n=13), 9.0 months for other patients receiving first-line platinum doublets (n=129), and 4.0 months with non-platinum chemotherapies (n=17, p<0.01). Other patient characteristics independently associated with longer OS were a lower baseline serum LDH (hazard ratio [HR] 0.54, p=0.008) and fewer initial metastatic sites (HR 0.52, p=0.006), while the platinum drug type (cisplatin vs. carboplatin) and cytotoxic partner (etoposide vs. paclitaxel), patients\' smoking status and baseline levels of tumor markers (NSE, CYFRA 21-1, CEA) did not matter. 12% (23/191) of patients forewent systemic treatment, mainly due to tumor-related clinical deterioration (n=13), while patient refusal of therapy (n=5) and severe concomitant illness (n=5) were less frequent. The attrition between successive treatment lines was approximately 50% and similar for platinum-based vs. other therapies, but higher in case of a worse initial ECOG status or higher serum LDH (p<0.05). 19% (36/191) of patients had secondary stage IV disease and showed fewer metastatic sites, better ECOG status and longer OS (median 12.6 vs. 8.7 months, p=0.030). Among the 111 deceased patients with palliative systemic treatment and complete follow-up, after exclusion of oligometastatic cases (n=8), administration of local therapies (n=63 or 57%) was associated with a longer OS (HR 0.58, p=0.008), but this association did not persist with multivariable testing.
CONCLUSIONS: Highly active systemic therapies, especially immunotherapy and platinum doublets, are essential for improved outcome in LCNEC and influence OS stronger than clinical disease parameters, laboratory results and other patient characteristics. The attrition between chemotherapy lines is approximately 50%, similar to other NSCLC. Patients with secondary metastatic disease have a more favorable clinical phenotype and longer survival.