Abstract：Objective This study aimed to investigate the prognostic factors and survival rate of lung large-cell neuroendocrine carcinoma (LCNEC). Methods The cross-sectional study was conducted. A total of 2 504 patients with lung LCNEC from January 2010 to December 2016 were included in the Surveillance, Epidemiology, and End ResultsDatabase. Among them, 1 357 were male and 1 147 were female, including 633 patients younger than 60 years old, 1 664 patients aged 60-80 years old, and 207 patients older than 80 years old. The survival rate of patients was calculated by the Kaplan-Meier method, and differences in the influence of different factors on survival rate were compared by Log-rank test. Cox proportional risk model for multifactor survival analysis was used to determine prognostic factors in patients with LCNEC. Results (1) The 3- and 5-year overall survival rates of 2 504 patients were 21.1% and 16.0%, and tumor-specific survival rates were 34.9% and 30.8%, respectively. (2) Single-factor analysis showed that the following factors were correlated with the prognosis of patients: patient age, sex, tumor site, side, tumor differentiation, American Joint Committee on Cancer (AJCC) lung cancer TNM 2017 eighth edition stage, tumor size and stage, regional lymph-node stage, presence of distant metastasis, presence of bone, liver, or brain metastasis, whether surgery was conducted, and whether chemotherapy was administered (all P values <0.05). No significant correlation of prognosis with insurance, marital status, and race was observed (all P values >0.05). (3) Multiple-factor analysis demonstrated that the following were independent risk factors for survival and prognosis: male, left lesion, lung cancer with higher TNM AJCC staging, larger mass, regional lymph-node metastasis, and liver-tissue metastasis (all P values <0.05). The mortality risk coefficient of patients undergoing surgery or chemotherapy were significantly lower than that of patients without surgery or chemotherapy (all P values <0.05). (4) Stratification analysis revealed no significant difference in overall survival and tumor-specific survival prognosis among patients with lung LCNEC without metastasis (all P values >0.05). In patients with metastasis, compared with patients without radiotherapy, radiotherapy can improve the overall survival rate and tumor-specific survival rate, and the differences were statistically significant (χ2=38.59, 19.08; all P values <0.01). Conclusion The prognosis of the patients with LCNEC are poor and the overall survival rates are lower. Surgery and chemotherapy can effectively prolong the overall survival time of patients and reduce the risk of death, which are independent protective factors for LCNEC prognosis. Patients without metastasis cannot benefit from radiotherapy. For patients who have metastases, radiation therapy is recommended.
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