Outcomes Of Patients With High-grade Neuroendocrine Carcinoma Of The Lung After Complete Resection

BACKGROUND: Lung cancer,accounting for the leading cause of cancer mortality in China,is one of the most common cancers.Large cell neuroendocrine carcinoma(LCNEC)and small cell lung cancer(SCLC)are all belong to high-grade neuroendocrine carcinomas.LCNEC is a rare and aggressive neoplasm.However,the characteristics and outcomes for LCNEC patients are still unclear and the treatment strategy for LCNEC is still controversial.The aim of this study was to evaluate the prognosis factors of patients with surgically-treated LCNEC.METHODS: From 2008 to 2014,we retrospectively reviewed a cohort of patients diagnosed with LCNEC,who had received complete resection and systematic nodal dissection in our hospital,the overall survival(OS)and disease-free survival(DFS)were investigated.RESULTS: Eighty-eight patients were enrolled,with an average age of 62.3 years(ranged from 35 to 78 years).5-year OS and DFS were 37.2% and 31.2%,respectively.Univariate analysis revealed that adjuvant chemotherapy,smoking history,surgical procedures and TNM stage were independent prognosis factors for OS and DFS(P<0.05 or P<0.01).The multivariate Cox model indicated that smoking history,postoperative chemotherapy and adjuvant chemotherapy were still independent prognostic factors for OS and DFS(P<0.01).CONCLUSION: LCNEC is a rare,aggressive,and preoperatively difficult-to-diagnosis tumor.Postoperative chemotherapy is beneficial for patients with complete resection and systematic nodal dissection.BACKGROUND: Small cell lung cancer(SCLC)is thought a systemic disease,and surgical indication for SCLC is very limited.Preoperative diagnostic capabilities sometimes can fail us to identify SCLC correctly,potentially leading to a small subset of unexpected patients with SCLC diagnosed only after pulmonary resections.METHODS: Clinical records of patients with post-operatively pathological-proven SCLC between 2008 and 2015 at a single institution were retrospectively reviewed.RESULTS: A total of 125 unexpected SCLC patients were identified.Of those,45 patients had a positron emission tomography(PET)examination pre-operatively.There is a higher consistency between clinical stage(c-stage)and pathologic stage(p-stage)in SCLC patients undergoing pre-operative PET examination than those not(24.4% vs.43.8%).Sixty-nine(55.2%)patients were diagnosed pre-operatively with poorly-differentiated carcinoma(n=22),sqamous canrcinoma(n=15),adenocarcinoma(n=10),malignant cells with necrosis(n=10),large cell carcinoma(n=8),and carcinoid(n=4).Survival comparisons showed a longer median overall survival(OS)in patients with a lobectomy(n=97)than patients with sub-lobar resections(n=28;hazards ratio [HR] =0.4801,p=0.0134).Multivariable analyses showed that the higher p-stage(HR=1.7349,p=0.0025),sub-lobar resection(vs.lobectomy,HR=1.9078,p=0.0395)as favourable prognostic factors for OS,and the presence of prophylactic cranial irradiation treatment(PCI,HR = 0.3873,p=0.0057)as the correponding favourable factors.CONCLUSIONS: PET examination facilitates the evaluation of disease stage of SCLCs.For unexpected SCLCs,favorable outcomes can be achieved if the following lobectomy and post-operative PCI are performed.BACKGROUND: To investigate prognostic factors and survival in combined small cell lung cancer(C-SCLC)patients after complete resection.METHODS: From January 2010 to December 2014,the medical records of C-SCLC patients who underwent complete resection and systematic nodal dissection in our hospital were retrospectively reviewed.RESULTS: Seventy-six patients with histologically diagnosed C-SCLC were enrolled in our study.The most common combined component was large cell neuroendocrine carcinoma(LCNEC,N=41),followed by squamous cell carcinoma(SCC,n=18),adenocarcinoma carcinoma(AC,n=9),and adenosquamous carcinoma(ASC,n=8).The overall survival(OS)rate of the entire cohort was 39.1%.Multivariate analyses revealed that size(<3cm vs.>3cm;HR =0.358;95% CI:0.224-0.785;P=0.012),performance status(<2 vs.>2;HR=0.121;95% CI:0.186-0.586;P=0.012),combined non-small-cell lung cancer(NSCLC)components(LCNEC vs.non-LCNEC HR=0.312;95% CI:0.085-0.543;P<0.001),adjuvant therapy(Yes vs.No;HR=0.376;95% CI:0.184-0.786;P=0.013)as significantly prognostic factors for OS.CONCLUSION: The mixed LCNEC components in C-SCLC had a significant influence on the survival.Adjuvant therapy is beneficial for patients with C-SCLC after en bloc resected.