Surgery best for large cell lung neuroendocrine cancer

  • Raman V & al.
  • J Thorac Oncol
  • 23 Sep 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Surgery for large cell lung neuroendocrine cancer (LCNEC) offers better survival than stereotactic body radiation therapy (SBRT) or chemoradiotherapy (CRT).

Why this matters

  • Few studies have examined treatment outcomes after surgery for LCNEC, an aggressive rare NSCLC tumor with properties similar to both small-cell lung cancer and NSCLC.

Study design

  • 6092 patients diagnosed with stage I-IIIA LCNEC between 2004 and 2015 from the National Cancer Database.
  • Funding: None disclosed.

Key results

  • Surgery rates were 96% in stage I, 94% in stage II, 75% in stage IIIA, and 62% in N2 disease.
  • 4% of stage I patients underwent SBRT; CRT was used in 6% of stage II, 25% of stage IIIA, and 38% of N2 patients.
  • Among surgery patients, 5-year OS was 50% in stage I, 45% in stage II, 36% in stage IIIA, and 32% in N2.
  • Surgery offered significantly better OS compared with SBRT in stage I disease (aHR, 0.70; 95% CI, 0.57-0.86) and CRT in stage II (aHR, 0.47; 95% CI, 0.35-0.63), stage IIIA (aHR, 0.69; 95% CI, 0.60-0.81), and N2 disease (aHR, 0.68; 95% CI, 0.56-0.82).
  • Survival in LCNEC surgical patients was poorer vs adenocarcinomas, but better vs small-cell lung cancer.

Limitations

  • Retrospective study.