肺大细胞神经内分泌癌临床特征及预后分析

Clinical characteristics and prognostic factors of pulmonary large cell neuroendocrine carcinoma

目的评估肺大细胞神经内分泌癌(pLCNEC)临床特征、肿瘤标志物、治疗方法等对预后的影响。方法通过电子病历回顾分析149例p LCNEC患者病历资料,通过Kaplan-Meier曲线及Cox回归分析患者临床特征、血清肿瘤标志物(NSE、CA125、CA153、CYFRA21-1)、病理类型(复合型、单纯型)以及治疗方法(手术、化疗、免疫治疗)等对预后的影响。结果149例患者中位年龄63岁,其中男136(91.28%)例;单纯pLCNEC 100例,复合型pLCNEC 49例;中位生存期为18(10,32)月。血清NSE、CA125、CA153、CYFRA21-1水平增高的患者总生存期(OS)明显缩短(HR分别为2.959、4.249、5.198、1.84,均P<0.05)。预后差的相关因素还包括:肿瘤TNM分期(与Ⅰ期患者比较,Ⅲ期、Ⅳ期患者的HR分别为4.074、9.470,P<0.05),淋巴结转移或远处转移(HR=1.815、4.083,P<0.05)。其中CA125、CA153、淋巴结转移、远处转移是预后的独立危险因素。接受手术治疗的Ⅰ-Ⅲ期患者OS明显延长(HR=0.357,P<0.05)。复合型pLCNEC与单纯pLCNEC的OS无差别,但合并小细胞肺癌的复合型pLCNEC预后更差(HR=2.051,P=0.024)。CEA、CA125、CA153阴性的患者手术治疗的HR分别为0.256、0.479、0.388(均P<0.05),而CEA、CA125、CA153阳性患者手术治疗的HR分别为0.548、0.628、0.746(均P>0.05)。结论CA125、CA153、淋巴结转移、远处转移是pLCNEC预后差的独立危险因素;合并小细胞肺癌的复合型pLCNEC预后更差;手术治疗显著改善Ⅰ~Ⅲ期pLCNEC患者预后。

Objective To evaluate the effect of different clinical features,tumor markers,TNM stage and treatment strategies on pulmonary large cell neuroendocrine carcinoma(pLCNEC).Methods A cohort of 149patients with pLCNEC were retrospectively enrolled.All data were collectedfrom the electronic medical records.The effect of clinical features and factors,including serum tumor markers(NSE,CA125,CA153,CYFRA21-1),TNM stage,pathological types(pure or combined),and treatment strategies on prognosis were analyzed by Kaplan Meier curve and Cox model.Results Of the 149 patients,the median age was 63 years and 136(91.28%)were males;100 were pure pLCNEC and 49 were combined pLCNEC.The median survival time was 18(10~32)months.The overall survival(OS)of patients with increased serum NSE,CA125,CA153 and CYFRA21-1 levels was significantly shorter(HR=2.959,4.249,5.198,1.84,P<0.05).The poor prognosis also associated with these factors including tumor TNM stage(compared with stage I patients,the HR of stageⅢandⅣpatients were4.074 and 9.470,respectively,P<0.05),N and M(HR=1.815,4.083,P<0.05).CA125,CA153,N and M were independent risk factors of poor prognosis.The stageⅠ-Ⅲpatients treated with surgery had significantly longer OS than patients treated without surgery(HR=0.357,P<0.05).The OS of combined pLCNEC patients was similar to pure p LCNEC patients,but the OS of pLCNEC patients combined with small cell lung cancer was significantly shorter(HR=2.051,P=0.024).Surgy-treatment was very efficient in patients with negative CEA,CA125 or CA153(HR=0.256,0.479,0.388,all P<0.05),but surgy-treatment became less efficient in patients with positive CEA,CA125 or CA153(HR=0.548,0.628,0.746,all P>0.05).Conclusion CA125,CA153,N and M are independent risk factors of poor prognosis of pLCNEC.The prognosis of pLCNEC combined with small cell lung cancer is worse.Surgical treatment significantly improved the prognosis of stageⅠ-Ⅲpatients.