The role of adjuvant therapy in the management of resected large cell neuroendocrine carcinoma (LCNEC) of the lung: A National Cancer Database (NCDB) analysis.

Abstract

8529 Background: Large cell neuroendocrine carcinoma (LCNEC) is characterized by aggressive behavior and poor outcomes compared with other non-small cell lung cancers (ONSCLC). Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with early stage NSCLC (pathologic stage I, II, IIIA) from 2004-2012 who underwent surgical resection. Patients were divided into two groups: LCNEC and ONSCLC. One-way ANOVA was used to compare continuous variables, and chi-squared testing was used to compare categorical variables. Multivariate logistic regression analyses were used to obtain hazard ratios. Results: We identified 1672 patients with resected LCNEC and 134139 with resected ONSCLC. A higher proportion of patients with ONSCLC had a Charlson-Deyo co-morbidity score of 0 compared to LCNEC patients (50.6% vs. 43.8%; p < 0.001). No other significant differences in clinical and demographic characteristics were identified. Overall survival was lower for LCNEC patients across all stages when compared to patients with resected ONSCLC (46 months versus 74 months; 5-year survival 45% versus 57%; p <0.001). Multivariate analysis confirmed the survival benefit for adjuvant chemotherapy in resected LCNEC across all stages, including stage IA, although it did not reach statistical significance (hazard ratio 0.72 (0.51-1.02), p= 0.64; Table). Conclusions: Adjuvant chemotherapy significantly improves survival for stage IB, II and IIIA LCNEC compared to surgery alone. Patients with stage IA LCNEC appear to benefit from adjuvant chemotherapy although it did not reach statistical significance. The overall magnitude of benefit from adjuvant chemotherapy appears to be higher for patients with LCNEC compared to ONSCLC. [Table: see text]