Factors associated with treatment receipt and overall survival for patients with locally advanced large cell neuroendocrine carcinoma of the lung: A National Cancer Database analysis. (December 2020)

• Record Type: Journal Article
• Authors: Limonnik, Vladimir; Abel, Stephen; Finley, Gene G.; Long, Gregory S.; Wegner, Rodney E.
• Is Part Of: Lung cancer. Volume 150(2020)
• Page Start: 107
• Page End: 113
• Publication Date: 2020-12
• Subjects: Large cell neuroendocrine carcinoma -- Small-cell lung cancer -- Non-small cell lung cancer -- National cancer database -- Radiation therapy -- Chemotherapy -- Chemoradiotherapy -- Cancer -- Malignancy -- Lung cancer; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.10.001
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Chemoradiation (CRT) is associated with an improvement in overall survival compared to chemotherapy (ChT) alone. Older patients and those with higher comorbidity scores were less likely to receive CRT. Patients with treatment receipt at an academic/research program facility, N2 disease, and later treatment year were more likely to receive CRT. CRT was an independent predictor of increased overall survival in patients with LCNEC. Abstract: Purpose: Large cell neuroendocrine carcinoma (LCNEC) is a rare pulmonary malignancy with clinicopathologic features of both non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Given the paucity of available data regarding LCNEC management, we queried the National Cancer Database (NCDB) to describe trends in management, identify predictors of treatment receipt, and compare outcomes in patients receiving chemotherapy (ChT) and chemoradiotherapy (CRT). Methods: We identified patients with locally advanced (Stage III) LCNEC of the lung treated with definitive ChT or CRT between the years of 2004−2015. Odds ratios were calculated to determine predictors of CRT receipt. Multivariable cox regression was used to determine predictors of overall survival. Results: Using the above criteria, 5797 patients were identified, 54 % of whom received CRT (n = 3153) while 46 % (n = 2644) received ChT alone. Most patients had T4 (35 %) and N2 (59 %) disease. Median overall survival was 11.9 months (11.3–12.6) in patients receiving ChT compared to 16.1 months (15.4–16.9) in patients receiving CRT (p < 0.0001). Overall survival at 1, 3, and 5 years was 50 %, 20 %, and 13 % versus 60 %, 27 %, and 18 %, in patients receiving ChT and CRT, respectively. Older patients and those with higher comorbidity scores were less likely to receive CRT; whereas patients with higher education level, treatment receipt at an academic/research program facility, N2 disease, and later treatment year were more likely to receive CRT. On multivariable analysis, older age, greater comorbidity score, presence of N2 disease, and presence of T4 disease were all associated with decreased OS. CRT receipt was an independent predictor of increased overall survival. Conclusions: Definitive CRT was an independent predictor of increased overall survival in patients with locally advanced LCNEC of the lung. Findings from our study may help guide potential areas of future investigation to help define an ideal treatment approach for LCNEC.