Large Cell Neuroendocrine Carcinoma Of The Lung: Analysis On Prognostic Factors And Survival

Background and objective.Large cell neuroendocrine carcinoma of the lung(LCNEC)is a rare endobronchial neoplasmcharacterized by aggressive biological behaviour and poor survival,and there is no consensus on treatment in patients with lung LCNEC.The project was designed to identify therapies associated with improved survival.Methods.Relevant data were abstracted from the SEER database.Univariate analysis was performed by Kaplan-Meier method.Multivariate analysis was performed by generating Cox proportional hazard ratios.We thoroughly collected relevant articles about chemotherapy for advanced large cell neuroendocrine carcinoma of the lung.Subsequently,eligible studies were identified according to the inclusion criteria.Moreover,95% confidence intervals(CIs)of overall survival(OS)were extracted.Eventually,this meta-analysis was performed via Stata 15.Results.We identified 3383 patients with LCNEC in the SEER database.Out of all patients,54.9% were men,45.1% were women,median age was 67years(18 to 94years).TNM stage was as follows: 25.5% had stage Ⅰ disease,8.2% had stage Ⅱ,21.2% had stage Ⅲ and 45.1% had stage Ⅳ.The overall median survival was 7 months(0-148 months).Median overall survival for stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ cancers was 27,16,11,and 4 months,respectively.Median overall survival for stage Ⅲ-Ⅳ cancers was 6 months.In a univariate analysis,age ofbelow 75(p< 0.001),female(p< 0.001),earlier stage(p< 0.001),well or moderate differentiated(p< 0.001)and tumor of upper lobe(p< 0.001)wereallsignificant good prognosticfactors.Surgery-only or radiation plus surgerywere associated with improved survival(p< 0.001).Withregardto radiation sequence with surgery,radiation prior to surgery(p<0.001)was associated with improved survival versus the all other sequences.In a multivariate analysis,75 yearsandolder(HR=1.557,95%CI [1.425-1.701],p< 0.001),laterstage(p< 0.001)increased the risk of death.Female(HR=0.819,95%CI [0.757-0.887],p< 0.001),surgery-only(HR=0.636,95%CI [0.548-0.739],p< 0.001)and radiation plus surgery(HR=0.592,95%CI [0.495-0.708],p< 0.001)were associated with improved survival.Tumor grade and location didnotaffectprognosis(p> 0.05).Meta-analysis included 6 eligible studies incorporating 230 patients with advanced LCNEC.A fixed-effect model was utilized because heterogeneity did not exist.The pooled OS of 6studieswss 9.657 months(95%CI [8.494-10.821]),which was significantlylonger thanmedian OS of stage Ⅲ-Ⅳ Large cell neuroendocrine carcinoma of the lung from SEER database.Conclusions.Most patients with LCNEC wereelderly men and initially diagnosed at advanced stage.Age of below 75,female and earlier stage wereallsignificant good prognosticfactors Surgery-only or radiation plus surgery prolonged the median OS.Chemotherapy for patients with stage Ⅲ-IVLCNEC obviously improved survival.