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Xing H, Wu C, Zhang D, Zhang X. Early death incidence and prediction in stage IV large cell neuroendocrine carcinoma of the lung. Medicine (Baltimore) 2024; 103:e39294. [PMID: 39287289 PMCID: PMC11404970 DOI: 10.1097/md.0000000000039294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/11/2024] [Accepted: 07/23/2024] [Indexed: 09/19/2024] Open
Abstract
Nearly half of lung large cell neuroendocrine carcinoma (LCNEC) patients are diagnosed at an advanced stage and face a high early death risk. Our objective was to develop models for assessing early death risk in stage IV LCNEC patients. We used surveillance, epidemiology, and end results (SEER) databases to gather data on patients with stage IV LCNEC to construct models and conduct internal validation. Additionally, we collected a dataset from the Second Affiliated Hospital of Nanchang University for external validation. We used the Pearson correlation coefficient and variance inflation factor to identify collinearity among variables. Logistic regression analysis and least absolute shrinkage and selection operator analysis were employed to identify important independent prognostic factors. Prediction nomograms and network-based probability calculators were developed. The accuracy of the nomograms was evaluated using receiver operating characteristic curves. The goodness of fit of the nomograms was evaluated using the Hosmer-Lemeshow test and calibration curves. The clinical value of the models was assessed through decision curve analysis. We enrolled 816 patients from the surveillance, epidemiology, and end results database and randomly assigned them to a training group and a validation group at a 7:3 ratio. In the training group, we identified 9 factors closely associated with early death and included them in the prediction nomograms. The overall early death model achieved an area under the curve of 0.850 for the training group and 0.780 for the validation group. Regarding the cancer-specific early death model, the area under the curve was 0.853 for the training group and 0.769 for the validation group. The calibration curve and Hosmer-Lemeshow test both demonstrated a high level of consistency for the constructed nomograms. Additionally, decision curve analysis further confirmed the substantial clinical utility of the nomograms. We developed a reliable nomogram to predict the early mortality risk in stage IV LCNEC patients that can be a helpful tool for health care professionals to identify high-risk patients and create personalized treatment plans.
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Affiliation(s)
- Hongquan Xing
- Department of Respiratory Diseases, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Cong Wu
- Department of Pathology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Dongdong Zhang
- Department of Respiratory Diseases, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xinyi Zhang
- Department of Respiratory Diseases, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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Wan S, Shen Z, Hu S, Zhang L, Yu H, Chen Y, Wang J, Wang D, Zhang J, Zhang P. Spread Through Air Spaces in Stage I Pulmonary Large Cell Neuroendocrine Carcinoma. Ann Thorac Surg 2024; 118:385-393. [PMID: 38242341 DOI: 10.1016/j.athoracsur.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Pulmonary large cell neuroendocrine carcinoma (LCNEC) represents an exceptionally aggressive and infrequent variant within the realm of non-small cell lung cancer, necessitating surgical intervention as the primary therapeutic approach. However, the postoperative management strategy for early-stage patients continues to be a subject of intense debate and uncertainty. METHODS A retrospective analysis was conducted on a cohort of patients diagnosed with LCNEC who underwent surgical resection at Shanghai Pulmonary Hospital between July 2018 and June 2022. Comprehensive assessments, encompassing univariate and multivariate analyses, were performed to evaluate the prognostic significance of these indicators in patient clinical profiles, overall survival (OS), and disease-free survival (DFS). RESULTS A comprehensive screening effort identified 171 patients with LCNEC, with 70 stage I patients meeting the criteria for inclusion in the final cohort. Of these, 11 patients (15.7%) presented with combined LCNEC, and 59 (84.3%) exhibited pure LCNEC. Univariate and multivariate analyses both unveiled that spread through air spaces (STAS) status emerged as an independent prognostic determinant for both DFS (P = .003) and OS (P = .013), whereas histologic subtype independently predicted OS (P = .011). Subgroup survival analyses further underscored that the advantageous effects of postoperative chemotherapy were significantly pronounced exclusively among STAS-positive patients, showcasing a statistically significant enhancement in DFS (P = .047) and OS (P = .018). CONCLUSIONS STAS may serve as an adverse prognostic factor in stage I LCNEC patients, potentially offering guidance for postoperative chemotherapy decisions.
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Affiliation(s)
- Shiyue Wan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziyun Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shiqi Hu
- The 1st School of Medicine, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lele Zhang
- Central Laboratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huansha Yu
- Experimental Animal Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jue Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Di Wang
- Tissue Bank of Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; The 1st School of Medicine, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Liu L, Zhang J, Zhao K, Guo C, Huang C, Li S, Chen Y. Prognostic factors and nomogram for pulmonary resected high-grade neuroendocrine carcinomas: a 20-year single institutional real-world experience. Orphanet J Rare Dis 2024; 19:232. [PMID: 38863016 PMCID: PMC11167916 DOI: 10.1186/s13023-024-03240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Pulmonary high-grade neuroendocrine carcinomas(pHGNEC) encompassing small cell lung cancer (SCLC) and large cell neuroendocrine carcinoma (LCNEC) are clinically aggressive tumors with poor prognosis. The role of surgery and prognostic factors guiding management remain unclear. We aimed to analyze prognosis following resection and identify predictive variables. METHODS This retrospective study analyzed 259 patients undergoing pHGNEC resection from 2001-2023. Overall survival (OS) and disease-free survival (DFS) were evaluated using Kaplan-Meier curves. Prognostic factors were assessed with Cox regression and visualized using nomogram tools. RESULTS Minimally invasive surgery was associated with better OS (p = 0.001) and DFS (p = 0.001). Higher T stage predicted worse OS (T2 p = 0.044, T4 p = 0.007) and DFS (T2 p = 0.020, T4 p = 0.004). Advanced TNM stage III (OS p = 0.018; DFS p = 0.015) and IV (OS p < 0.001; DFS p < 0.001) also correlated with poorer prognosis. In the SCLC subgroup, elevated preoperative CEA independently predicted worse OS (p = 0.012) and DFS (p = 0.004). T4 disease (OS p < 0.001; DFS p = 0.002) and advanced TNM staging (stage III OS p = 0.043; DFS p = 0.045; stage IV OS p < 0.001, DFS p < 0.001) were associated with worse outcomes. In LCNEC patients, VATS resection improved OS (p = 0.048) and DFS (p = 0.027) despite conversion. Prior malignancy predicted worse OS (p < 0.001). Advanced TNM disease (stage III OS p = 0.047; stage IV OS p = 0.003, DFS p = 0.005) were also negative prognostic factors. The prognostic nomogram incorporating above variables effectively stratified risk. Calibration plots revealed good correlation between predicted and actual survival. CONCLUSIONS We identified minimally invasive surgery, early TNM stage, younger age, and normal preoperative CEA as positive prognostic factors following pHGNEC resection. Our study provides an applicable prognostic nomogram to facilitate personalized pHGNEC management.
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Affiliation(s)
- Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China
| | - Ke Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China.
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Evangelou G, Trontzas IP, Gkiozos I, Vamvakaris I, Paraskeva C, Grammoustianou M, Gomatou G, Tsamis I, Vathiotis I, Anagnostakis M, Koliaraki V, Syrigos K. The Effectiveness of Atezolizumab in Metastatic Large Cell Neuroendocrine Carcinoma of the Lungs: Insights from the LANCE Pilot Study. Biomedicines 2024; 12:1161. [PMID: 38927367 PMCID: PMC11200835 DOI: 10.3390/biomedicines12061161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/06/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Large cell neuroendocrine carcinoma (LCNEC) presents significant treatment challenges due to its rarity and limited therapeutic options. The LANCE study was designed to explore the survival benefits of incorporating atezolizumab in chemotherapy for metastatic LCNEC. METHODS In this non-randomized study, patients with metastatic LCNEC were prospectively enrolled and assigned to receive either standard chemotherapy plus atezolizumab followed by maintenance with atezolizumab or standard chemotherapy alone. The primary outcomes measured were 12- and 24-month survival rates, progression-free survival (PFS), and overall survival (OS) between the two groups. RESULTS Of the 22 patients screened, 17 met the inclusion criteria and received either atezolizumab plus platinum-based chemotherapy (n = 10) or chemotherapy alone (n = 7). After a median follow-up of 23.3 months, the 12-month survival rate was 57.1% (95% CI: 32.6-100%) and 14.3% (95% CI: 2.33-87.7%) for the atezolizumab and the chemotherapy-only groups, respectively. The survival benefit for the atezolizumab group was sustained at 24 months (45.7% vs. 14.3%). Overall survival was significantly higher for the atezolizumab group, and PFS was non-significantly associated with the addition of atezolizumab (log-rank p = 0.04 and 0.05, respectively). CONCLUSIONS This pilot study suggests that the addition of atezolizumab to standard platinum-based chemotherapy may provide a substantial survival benefit compared with chemotherapy alone in the first-line treatment of metastatic LCNEC.
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Affiliation(s)
- Georgios Evangelou
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
| | - Ioannis P. Trontzas
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
| | - Ioannis Gkiozos
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
| | - Ioannis Vamvakaris
- Department of Pathology, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece;
| | - Christina Paraskeva
- Biomedical Sciences Research Center “Alexander Fleming”, Fleming 34, 16672 Vari, Greece; (C.P.)
| | - Maria Grammoustianou
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
| | - Georgia Gomatou
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
| | - Ioannis Tsamis
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
| | - Ioannis Vathiotis
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
| | - Maximillian Anagnostakis
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
| | - Vasiliki Koliaraki
- Biomedical Sciences Research Center “Alexander Fleming”, Fleming 34, 16672 Vari, Greece; (C.P.)
| | - Kostas Syrigos
- 3rd Department of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Mesogeion 152, 11527 Athens, Greece; (I.P.T.); (I.G.); (M.G.); (G.G.); (I.T.); (I.V.); (M.A.); (K.S.)
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