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. 2021 Jan;10(1):71-79.
doi: 10.21037/tlcr-20-374.

Outcomes for localized treatment of large cell neuroendocrine carcinoma of the lung in the United States

Michael S May  1 , Connor J Kinslow  2 , Christopher Adams  3 , Anjali Saqi  4 , Catherine A Shu  1   5 , Kunal R Chaudhary  2 , Tony J C Wang  2   5 , Simon K Cheng  2   5
Affiliations

Outcomes for localized treatment of large cell neuroendocrine carcinoma of the lung in the United States

Michael S May et al. Transl Lung Cancer Res. 2021 Jan.

Abstract

Background: Treatment paradigms for large cell neuroendocrine carcinoma (LCNEC) of the lung are based largely upon small retrospective studies and smaller prospective trials. It is unclear if these tumors behave like non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). Data are lacking with regard to the role of radiotherapy (RT). U. S. guidelines recommend that LCNEC be treated as a NSCLC. We sought to perform a cross-sectional study of LCNEC cases to understand treatment paradigms and outcomes in this disease.

Methods: The Surveillance, Epidemiology and End Results database was queried for cases of stage I-III pulmonary LCNEC diagnosed 2004-2013. Treatment groups were defined as no surgery, RT alone, surgery alone, and surgery + RT. The Cox-proportional hazards regression model was used to compare overall survival and cause-specific survival (OS/CSS), stratified by AJCC 6th Staging. Factors that were significant on univariable analysis were included in multivariable analysis.

Results: We identified 1,523 cases of LCNEC, with 748, 177, and 598 cases of stage I, II, and III disease, respectively. In stage I and II disease, RT was associated with improved survival for non-surgical patients, but not for those who underwent surgery. In stage I disease, the adjusted hazard ratios for OS for RT alone, surgery, and surgery + RT were 0.39, 0.21, and 0.22, respectively (P<0.001). In stage II disease, the adjusted hazard ratios for RT alone, surgery, and surgery + RT were 0.51 (P=0.15), 0.39 (P=0.004), and 0.38 (P=0.01), respectively. For patients with stage III disease, RT was associated with improved survival in surgical and non-surgical patients. The adjusted hazard ratios for RT alone, surgery, and surgery + RT were 0.49, 0.43, and 0.36, respectively (P<0.001).

Conclusions: Our findings indicate that non-metastatic LCNEC may be treated as a NSCLC with respect to RT. Prospective studies are necessary to increase our understanding of optimal treatment regimens.

Keywords: Large cell neuroendocrine carcinoma of the lung (LCNEC of the lung); SEER database; lung cancer treatment; neuroendocrine carcinoma.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-374). CAS receipt of personal fees from Genentech, personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, outside the submitted work. TJCW reports personal fees and non-financial support from AbbVie, personal fees from AstraZeneca, personal fees from Cancer Panels, personal fees from Doximity, personal fees and non-financial support from Elekta, personal fees and non-financial support from Merck, personal fees and non-financial support from Novocure, personal fees and non-financial support from RTOG Foundation, personal fees from Rutgers, personal fees from University of Iowa, personal fees from Wolters Kluwer, grants and non-financial support from Genentech, outside the submitted work. SKC reports personal fees and non-financial support from AbbVie and Sanofi, outside of the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Cox-regression multivariable analysis of overall survival according to stage for RT, surgery, RT and surgery or neither surgery nor RT (A,B,C). Variables included in the model are displayed in Tables S5-S7. RT, radiotherapy.
See this image and copyright information in PMC

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