Prognostic factors for surgically resected pulmonary large cell neuroendocrine carcinoma: A single-institution real-world experience.

Abstract

e20033 Background: Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare, highly aggressive malignancy with a poor prognosis, accounting for approximately 3% of all lung cancers. LCNEC exhibits features of both small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC), complicating diagnosis and treatment strategies. This study aims to identify clinical characteristics and prognostic factors in LCNEC patients following surgery resection. Methods: This retrospective study evaluated 44 patients with histologically confirmed LCNEC who underwent surgical resection between July 2016 and January 2024 at the First Affiliated Hospital of Dalian Medical University (Table 1). We analyzed clinical features, surgical interventions, pathology and immunohistochemistry, TNM stage, and perioperative treatment. Kaplan-Meier survival curves and Cox regression models were used to identify prognostic factors for disease-free survival (DFS) and overall survival (OS). Results: The median DFS was 26.0 months (range 18.5-40.0 months), and the median OS was 77.0 months (range 50.4-96.5 months). The 2-year and 3-year DFS rates were 59.09% and 36.1%, respectively. Univariate analysis revealed that pure LCNEC (DFS HR: 0.224, p =0.007; OS HR: 0.281 p =0.003), P53 mutation (DFS HR: 0.183, p =0.035; OS HR: 0.230 p =0.049), and adjuvant chemotherapy with EP/EC (DFS HR: 0.372 p =0.034; OS HR: 0.292p =0.002) were significantly associated with improved DFS and OS. Multivariate analysis identified pure LCNEC, p53 mutation, and adjuvant therapy with EP/EC as independent factors associated with better DFS. Conclusions: Our study highlights pure LCNEC, p53 mutation, and adjuvant chemotherapy with EP/EC as favorable prognostic factors following surgical resection. Univariate and multivariate analysis of DFS. Factors Univariate analysis Multivariate analysis Hazard ratio (95% CI) P value Hazard ratio (95% CI) P value Gender (male/female) 0.888 (0.210 - 3.755) 0.872 Age (<60 vs. ≥60) 0.586 (0.204 - 1.684) 0.321 Smoking history (yes vs. no) 0.935 (0.453 - 1.929) 0.856 CEA (>1.70ng/ml) (yes vs. no) 0.979 (0.435 - 2.204) 0.960 NSE (>12.28ng/ml) (yes vs. no) 0.948 (0.223 - 4.036) 0.943 Cyfra211 (>2.70ng/ml) (yes vs. no) 0.730 (0.270 - 1.974) 0.535 pro-GRP (>35.77pg/ml) (yes vs. no) 0.511 (0.159 - 1.636) 0.258 Histology (Pure vs. Combined) 0.281 (0.122 - 0.646) 0.003 0.426 (0.171 - 1.060) 0.066 Ki-67 (≥30% vs. <30%) 1.021 (0.287 - 3.629) 0.975 P53 (Mutation vs. Wild) 0.230 (0.045- 0.986) 0.049 0.551 (0.204 - 1.493) 0.242 Vascular cancer thrombus (yes vs. no) 1.159 (0.470 - 2.856) 0.749 Pleural Invasion (yes vs. no) 2.507 (1.150 - 5.464) 0.021 0.528 (0.192 - 1.447) 0.214 Tumor size (>3cm vs. ≤3cm) 1.408 (0.649 - 3.055) 0.386 Lymph node metastasis (yes vs. no) 1.348 (0.619 - 2.934) 0.452 Chemotherapy (EP/EC vs. Others) 0.292 (0.135 - 0.632) 0.002 1.621 (0.678 - 3.877) 0.278 Thoracic Radiotherapy (yes vs. no) 0.420 (0.136 - 1.297) 0.131 Prophylactic cranial irradiation (yes vs. no) 1.621 (0.678 - 3.877) 0.278