Outcomes of patients with large cell neuroendocrine carcinoma oflung after complete resection

doi:10.3877/cma.j.issn.2095-8773.2016.03.03

Abstract

Abstract:

Objective

To investigate the clinical characteristics, outcomes after surgical resectionand prognostic factors of large cell neuroendocrine carcinoma (LCNEC) of lung.

Methods

The clinical data of a cohort of 90 patients undergoingsurgical resection and systematic nodal dissection for LCNEC between January 2008 and December 2014 in Shanghai Chest Hospital affiliated to Shanghai Jiaotong University were retrospectively analyzed. All patients were divided into adjuvant chemotherapy group(64 cases) and non-chemotherapy group(26 cases). The follow-up ranged from 1 to 100 months, and the overall survival(OS) and disease-free survival(DFS) were observed.

Results

There were 80 males and 10 females, with an average age of 62.2 years(ranged from 36 to 79 years) andmedian survival of 35 months. OS and DFS were 36.2% and 32.2%, respectively. Univariate analysis revealed that adjuvant chemotherapy, surgical procedures, smoking historyand TNM stage were independent prognostic factors for OS and DFS (P<0.05 or P<0.01). Multivariate analysis using COX proportional hazards models indicatedthat smoking history, postoperative pathological stageand adjuvant chemotherapy were significant prognostic factors for OS and DFS(P<0.01).

Conclusions

LCNEC is a rare and aggressive malignancy which is difficulttodiagnose before operation. Postoperative chemotherapy is beneficial for patients with complete resection and systematic nodal dissection.

Key words: Large cell neuroendocrine carcinoma of lung, Surgery, Postoperative chemotherapy, Overall survival, disease free survival

Ke Han, Haitang Yang, Liwen Fan, Heng Zhao. Outcomes of patients with large cell neuroendocrine carcinoma oflung after complete resection[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(03): 138-143.

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References 15

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指标		例数(%)
性别		?
?	男性	80(88.9)
?	女性	10(11.1)
年龄		?
?	≥62岁	45(50)
?	<62岁	45(50)
吸烟史		?
?	是	64(71.1)
?	否	26(28.9)
体力状况		?
?	0级	82(91.1)
?	1级	8(8.9)
手术方式		?
?	叶切＋袖切	71(78.9)
?	双肺叶切＋全肺叶切	19(21.1)
TNM分期		?
?	Ⅰ期	36(40)
?	Ⅱ期	14(15.5)
?	Ⅲ期	40(44.4)
肿瘤直径		?
?	>3 cm	53(58.9)
?	≤3 cm	37(41.1)
肿瘤位置		?
?	中央型	21(23.3)
?	周围型	69(76.7)
淋巴结分期		?
?	N0	42(46.7)
?	N1	15(16.7)
?	N2	33(36.7)
辅助治疗		78 (86.7)
?	无	12(13.3)
?	化疗	64(71.1)
?	放疗	14(15.5)
首次复发及转移		55 (61.1)
?	局部＋区域	18(20.0)
?	肺内＋胸膜	7(7.8)
?	骨	8(8.9)
?	腹部	7(7.8)
?	颅脑	15(16.7)

指标		例数(%)
性别		?
?	男性	80(88.9)
?	女性	10(11.1)
年龄		?
?	≥62岁	45(50)
?	<62岁	45(50)
吸烟史		?
?	是	64(71.1)
?	否	26(28.9)
体力状况		?
?	0级	82(91.1)
?	1级	8(8.9)
手术方式		?
?	叶切＋袖切	71(78.9)
?	双肺叶切＋全肺叶切	19(21.1)
TNM分期		?
?	Ⅰ期	36(40)
?	Ⅱ期	14(15.5)
?	Ⅲ期	40(44.4)
肿瘤直径		?
?	>3 cm	53(58.9)
?	≤3 cm	37(41.1)
肿瘤位置		?
?	中央型	21(23.3)
?	周围型	69(76.7)
淋巴结分期		?
?	N0	42(46.7)
?	N1	15(16.7)
?	N2	33(36.7)
辅助治疗		78 (86.7)
?	无	12(13.3)
?	化疗	64(71.1)
?	放疗	14(15.5)
首次复发及转移		55 (61.1)
?	局部＋区域	18(20.0)
?	肺内＋胸膜	7(7.8)
?	骨	8(8.9)
?	腹部	7(7.8)
?	颅脑	15(16.7)

变量		DFS		OS
变量		均数	P值	均数	P值
性别		?	0.650	?	0.501
?	女性	38.6±11.8	?	44.1±11.9	?
?	男性	45.0±4.6	?	50.6±4.4	?
年龄		?	0.697	?	0.962
?	<62岁	45.8±6.3	?	49.4±5.8	?
?	≥62岁	43.2±6.2	?	51.2±6.0	?
肿瘤直径		?	0.065	?	0.049
?	≤3 cm	52.8±6.6	?	58.3±6.0	?
?	>3 cm	39.1±5.8	?	44.6±5.8	?
吸烟史		?	0.003	?	<0.001
?	否	64.6±7.1	?	75.1±6.8	?
?	是	27.4±3.0	?	30.5±2.6	?
位置		?	0.08	?	0.039
?	周围型	48.3±5.1	?	54.4±4.8	?
?	中央型	28.8±6.8	?	32.3±6.7	?
TNM分期		?	<0.001	?	<0.001
?	Ⅰ期	63.8±6.6	?	71.5±6.2	?
?	Ⅱ期	67.6±7.4	?	69.7±9.9	?
?	Ⅲ期	15.5±2.3	?	21.7±2.2	?
手术方式		?	0.039	?	0.005
?	叶切＋袖切	48.7±5.0	?	56.1±4.9	?
?	双肺叶切＋全肺叶切	23.2±5.2	?	24.8±4.1	?
术后辅助化疗		?	0.038	?	0.207
?	是	50.1±5.4	?	59.9±5.0	?
?	否	29.4±6.4	?	34.3±6.3	?
术后辅助放疗		?	0.027	?	0.498
?	是	41.3±5.6	?	43.1±4.4	?
?	否	41.9±5.0	?	50.2±5.1	?

变量		DFS		OS
变量		均数	P值	均数	P值
性别		?	0.650	?	0.501
?	女性	38.6±11.8	?	44.1±11.9	?
?	男性	45.0±4.6	?	50.6±4.4	?
年龄		?	0.697	?	0.962
?	<62岁	45.8±6.3	?	49.4±5.8	?
?	≥62岁	43.2±6.2	?	51.2±6.0	?
肿瘤直径		?	0.065	?	0.049
?	≤3 cm	52.8±6.6	?	58.3±6.0	?
?	>3 cm	39.1±5.8	?	44.6±5.8	?
吸烟史		?	0.003	?	<0.001
?	否	64.6±7.1	?	75.1±6.8	?
?	是	27.4±3.0	?	30.5±2.6	?
位置		?	0.08	?	0.039
?	周围型	48.3±5.1	?	54.4±4.8	?
?	中央型	28.8±6.8	?	32.3±6.7	?
TNM分期		?	<0.001	?	<0.001
?	Ⅰ期	63.8±6.6	?	71.5±6.2	?
?	Ⅱ期	67.6±7.4	?	69.7±9.9	?
?	Ⅲ期	15.5±2.3	?	21.7±2.2	?
手术方式		?	0.039	?	0.005
?	叶切＋袖切	48.7±5.0	?	56.1±4.9	?
?	双肺叶切＋全肺叶切	23.2±5.2	?	24.8±4.1	?
术后辅助化疗		?	0.038	?	0.207
?	是	50.1±5.4	?	59.9±5.0	?
?	否	29.4±6.4	?	34.3±6.3	?
术后辅助放疗		?	0.027	?	0.498
?	是	41.3±5.6	?	43.1±4.4	?
?	否	41.9±5.0	?	50.2±5.1	?

变量	DFS			OS
变量	HR	95% CI	P值	HR	95% CI	P值
女性组vs男性组	0.973	0.375～2.523	0.955	1.295	0.537～3.121	0.565
年龄<62岁组vs年龄≥62岁组	0.774	0.436～1.375	0.382	0.929	0.504 ～1.713	0.815
肿瘤直径≤3 cm组vs肿瘤直径>3 cm组	0.671	0.356～1.265	0.218	0.635	0.328～1.228	0.177
未吸烟组vs吸烟组	0.424	0.215～0.837	0.013	0.342	0.159～0.736	0.006
周围型组vs中央型组	0.686	0.306～1.538	0.360	0.813	0.380～1.737	0.592
Ⅰ期组vsⅢ期组	0.102	0.47～0.223	<0.001	0.093	0.41～0.212	<0.001
Ⅱ期组vsⅢ期组	0.093	0.34～0.258	<0.001	0.115	0.42～0.314	<0.001
叶切＋袖切组vs双肺叶切＋全肺切组	1.459	0.742～2.868	0.274	1.157	0.466～2.871	0.754
术后化疗组vs术后未化疗组	0.290	0.154～0.548	<0.001	0.218	0.109～0.439	<0.001
术后放疗组vs术后未放疗组	0.537	0.272～1.063	0.074	0.597	0.308～1.158	0.127

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