The role of radiotherapy in pulmonary large cell neuroendocrine carcinoma: propensity score matching analysis

Abstract

<jats:title>Abstract</jats:title> <jats:p>The aim of the study was to investigate the survival advantage of radiotherapy (RT) in patients with pulmonary large cell neuroendocrine carcinoma (LCNEC). Patients with pulmonary LCNEC were extracted from the Surveillance, Epidemiology, and End Results (SEER) dataset between January 2004 and December 2013. Propensity score matching (PSM) analysis with 1:1 was used to ensure well-balanced characteristics of all comparison groups. A total of 1480 eligible cases were identified, with a median follow-up time of 11 months (0–131 months). After PSM, 980 patients were classified in no radiotherapy (No RT) and radiotherapy (RT) groups (n = 490 each). Patients in the RT group harbored significantly higher 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates compared to those in the No RT group (both P &amp;lt; 0.05). Furthermore, RT was an independent favorable prognostic factor of OS as well as CSS in multivariate analysis, both before [OS: hazard ratio (HR) 0.840, 95% confidence interval (CI) 0.739–0.954, P = 0.007; CSS: HR 0.847, 95% CI 0.741–0.967, P = 0.014] and after (OS: HR 0.854, 95% CI 0.736–0.970, P = 0.016; CSS: HR 0.848, 95% CI 0.735–0.978, P = 0.023) PSM. In subgroup analysis, American Joint Committee on Cancer (AJCC) stage II and III, tumor size 5-10 cm, patients who underwent no surgery, or patients who received chemotherapy could significantly benefit from RT (all P &amp;lt; 0.05). To sum up, our findings suggested that RT could prolong the survival of patients with pulmonary LCNEC, especially those with stage II and III, tumor size 5-10 cm, those with no surgery, or those who received chemotherapy.</jats:p>

Large Cell Neuroendocrine Carcinoma of the Lung: Current Understanding and Challenges

“…Furthermore, the role of post-operative RT was evaluated in two large retrospective trials among patients with resected early-stage LCNEC, demonstrating that RT was not associated with survival benefit [ 63 , 64 ]. On the contrary, a recent large-population based study including 1480 LCNEC patients showed that RT could yield a survival benefit in patients with stage II-III LCNEC, a tumor size of 5–10 cm, and who had not been treated with surgery or were among patients who received chemotherapy [ 71 ].…”

Clinical features and treatment outcomes of resected large cell neuroendocrine carcinoma of the lung

“…Brain metastasis rate and brain metastasis-free survival rate were significantly better than those for SCLC, with or without PCI. Notwithstanding, older age, primary location (main bronchus), and no adjuvant chemotherapy have been shown to exhibit significant associations with poor prognosis in previous studies [7,10]. LCNEC has been regarded as a disease entity that shows features of both NSCLC and SCLC.…”

“…However, the most appropriate regimen (whether to follow the NSCLC-regimen or SCLC regimen) and the schedule of them are still not established, independently of the clinical stage of LCNEC [8]. Furthermore, the role of radiotherapy as post-operative treatment of local or advanced pulmonary LCNEC remains unclear, but some have suggested its use in the locally advanced disease setting [9,10]. Some researchers have recently proposed the need for prophylactic cranial irradiation (PCI) for this disease entity, based on its dismal prognosis and its high rate of brain metastasis, similar to SCLC, but a consensus has yet to be reached [10].…”

Puntajes de propensión y estudios observacionales. Aplicaciones en investigación quirúrgica

“…Luego, verificar que las covariables estén equilibradas entre el grupo de intervención o exposición y el de control de la nueva muestra emparejada. Finalmente, realizar un análisis multivariado sobre la base de la nueva muestra [23][24][25][26] (Figura 5).…”

“…La estimación de las PP se puede realizar en paquetes estadísticos tradicionales, recomendándose el uso de "R" y "STATA" 22,[27][28][29] . Sin embargo, también hay evidencia del uso de SAS y SPSS 22,25,26,28,29 .…”