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Pulmonary large cell neuroendocrine carcinoma (LCNEC): a population-based study addressing recent molecular-genetic advances and emerging therapeutic approaches

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Abstract

Background

Large cell neuroendocrine carcinoma (LCNEC) of the lung is a rare, aggressive cancer most commonly found in the lungs but not exclusively, with a worse prognosis than non-small cell lung carcinomas. Currently, LCNEC patients are treated using small cell and non-small cell protocols. This study aims to use the SEER database to identify demographic, clinical, pathological, and therapeutic factors affecting the prognosis and survival of patients with LCNEC of the lung.

Methods

Demographic, clinical, and management data of patients with lung LCNEC were extracted from the SEER database for the period 2000–2018.

Results

In the USA, LCNEC has a higher incidence in elderly white men: M:F ratio = 1.2:1, Caucasian: 83.3%, mean age: 67 ± 10.2 years. The most common treatment modality was chemotherapy only: 29.2%, followed by surgery: 21.5% (but in this group the statuses of chemotherapy were unknown), and combination surgery/chemotherapy: 8.8%. The overall and cause-specific 5-year survival was 17.5% (95% CI 16.3–18.8) and 21.9% (95% CI 20.5–23.4), respectively. By treatment, the best 5-year survival was for surgery alone (48%), followed by multimodality therapy (chemo + surgery + radiation) at 35% (95% CI 27–43). Age > 60 years, male gender, size > 7 cm, and nodal and liver metastasis were independent risk factors associated with increased mortality.

Conclusion

Lung LCNEC is an aggressive neoplasm most common in older white males that presents at an advanced stage despite small primary tumors. Most patients die within 2 years. The best predictor of survival is surgery with chemotherapy. Given its dismal prognosis, new treatment guidelines are needed for this aggressive cancer.

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Data availability

All data are publicly available.

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Funding

This research received no external funding.

Author information

Author notes

  1. Jaffar Khan and Abdul Qahar Khan Yasinzai have contributed equally to this work.

Authors and Affiliations

  1. Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA

    Jaffar Khan & Hector Mesa

  2. Bolan Medical College, Quetta, Pakistan

    Abdul Qahar Khan Yasinzai

  3. Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA

    Sabrina Matosz

  4. Department of Medicine, Marshfield Clinic, Marshfield, WI, USA

    Marjan Khan

  5. Molecular Pathology Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA

    Saleh Heneidi

  6. Department of Hematology and Oncology, University of Kentucky, Lexington, USA

    Aman Chauhan

  7. Division of Hematology and Oncology, National Cancer Institute, NIH, Bethesda, MD, 20892, USA

    Jaydira Del Rivero

  8. Inova Schar Cancer Institute, Department of Medicine, University of Virginia, Fairfax, VA, 22031, USA

    Nagla Abdel Karim

  9. Department of Pathology and Laboratory Medicine, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, 37232, USA

    Asad Ullah

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Contributions

All authors contributed to this manuscript. JK and AU conceptualized the study. JK, AQK, SM, MK, and AU helped in literature search, writing—original draft preparation.. AU, SH, HMAC, and JDR contributed to writing—review and editing. NAK, HM, AC supervised the study. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Asad Ullah.

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The authors declare no conflict of interest.

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Patient consent was waived due to this article being from SEER database, which are publicly available deidentified patients’ data from National Cancer Institute (NCI), USA.

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Khan, J., Yasinzai, A.Q.K., Matosz, S. et al. Pulmonary large cell neuroendocrine carcinoma (LCNEC): a population-based study addressing recent molecular-genetic advances and emerging therapeutic approaches. Clin Exp Med 23, 3947–3955 (2023). https://doi.org/10.1007/s10238-023-01071-8

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  • DOI: https://doi.org/10.1007/s10238-023-01071-8

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