Ann Thorac Surg 2019 Apr 17. Epub 2019 Apr 17.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center.
Background: Current guidelines do not routinely recommend adjuvant therapy for resected stage I large cell lung neuroendocrine cancer (LCNEC). However, data regarding the role of adjuvant therapy in early LCNEC are limited. This National Cancer Database (NCDB) analysis was performed to improve the evidence guiding adjuvant therapy for early LCNEC.
Methods: Overall survival (OS) of patients with pathologic T1-2aN0M0 LCNEC who underwent surgery in the NCDB from 2003 to 2015 was evaluated with Kaplan-Meier and multivariable Cox proportional hazards analyses. Patients who died within 30 days of surgery and with >R0 resection were excluded.
Results: Of 2642 patients meeting study criteria, 481 (18%) received adjuvant therapy. Adjuvant chemotherapy in stage IB patients was associated with a significant increase in OS (hazard ratio [HR] 0.67; 95% confidence interval [CI] 0.50, 0.90). However, there was no significant difference in survival between adjuvant chemotherapy and no adjuvant therapy for stage IA LCNEC (HR 0.92; 95%CI 0.75, 1.11). Adjuvant radiation, whether alone or in combination with chemotherapy, was not associated with a change in OS. In subgroup analysis, patients receiving adjuvant chemotherapy following lobar resection for stage IB LCNEC had a significant survival benefit compared to patients not receiving adjuvant therapy.
Conclusions: In early stage LCNEC, adjuvant chemotherapy appears to confer an additional overall survival advantage only in patients with completely resected stage IB LCNEC and not for patients with completely resected stage IA LCNEC.