Adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers as prognostic factors of early-stage large-cell neuroendocrine carcinoma

Thorac Cancer. 2022 Apr;13(7):900-912. doi: 10.1111/1759-7714.14287. Epub 2022 Feb 16.

Abstract

Background: We investigated whether adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers affected survival of patients with the early stage of large-cell neuroendocrine cancer.

Methods: This was a retrospective multicenter study including consecutive patients undergoing resection of node negative large-cell neuroendocrine carcinoma. Five-year survival and disease-free survival rate were evaluated by the Kaplan-Meier method and the log-rank test in relation to adjuvant chemotherapy, extent of resection, and immunoistochemical neuroendocrine markers (synaptophysin, chromogranin A, and neuron-specific enolase).

Results: Our study population included 117 patients; 47 (40%) of these received adjuvant chemotherapy. Patients treated with adjuvant chemotherapy had better survival (74% vs. 45%, p = 0.002) and disease-free survival (79% vs. 40%, p = 0.001) in all cases except patients with tumor <20 mm (79.5% vs. 57.4%, p = 0.43). Lobectomy compared to sublobar resection was associated with better survival (67% vs. 0.1%, p < 0.0001) and disease-free survival (65% vs. 0.1%, p < 0.0001) also in patients with tumor <20 mm (79% vs. 28%, p = 0.001). Patients with triple-positive neuroendocrine markers had better survival (79% vs. 35%, p = 0.0001) and disease-free survival (69% vs. 42%, p = 0.0008). Regression analysis showed that tumor size <20 mm, lobectomy, adjuvant chemotherapy, and triple-positive immunistochemical neuroendocrine markers were significant favorable prognostic factors for survival outcomes.

Conclusions: Lobectomy seems to be the management of choice in patients with large-cell neuroendocrine cancer <20 mm while adjuvant chemotherapy should be administered only in patients with tumor >20 mm.

Keywords: adjuvant chemotherapy; immunoistochemical neuroendocrine markers; large-cell neuroendocrine carcinoma; lobectomy; surgery.

Publication types

  • Multicenter Study

MeSH terms

  • Carcinoma, Neuroendocrine* / drug therapy
  • Carcinoma, Neuroendocrine* / pathology
  • Carcinoma, Neuroendocrine* / surgery
  • Chemotherapy, Adjuvant
  • Humans
  • Lung Neoplasms* / pathology
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies