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1. Ⅰ~Ⅲ期 LCNEC 患者
手术切除是早期 LCNEC 患者的主要治疗手段。但没有证据表明手术方式和术后整体生存率有明显关系［28］。多项回顾性分析显示，完全切除的Ⅰ期 LCNEC 患者，术后接受以铂类为基础两药方案的辅助化疗比单纯手术治疗生存获益更显著［29-30］。尽管缺乏随机Ⅲ期临床研究，目前的研究结果强调了早期 LCNEC 综合治疗的重要性，以铂类为基础的化疗方案是早期患者辅助治疗的首选［31］。胸部放疗或预防性脑照射的作用目前仍不清楚，没有证据表明放疗能使 LCNEC患者获益［32］。
2. 进展期及晚期 LCNEC 患者
这类患者治疗策略的选择仍存在争议。一项纳入 5 797 例局部晚期 LCNEC 患者的回顾性研究显示，根治性同步放化疗较单纯化疗效果更佳［33］。美国临床肿瘤学会同时推荐 SCLC 与 NSCLC 的治疗方案用于 LCNEC，但最近一项基于基因组研究结果表明，RB1 野生型和 / 或表达 RB1 蛋白的 LCNEC 按 NSCLC 化疗方案治疗，OS 明显优于 SCLC 化疗方案［34］。
3. 晚期 LCNEC 免疫治疗
一项回顾性研究显示，纳武利尤单抗或帕博利珠单抗治疗经治晚期 LCNEC 患者，60% 患者疗效为 PR，10% 患者疗效为 SD，PFS 为 57 周，患者耐受性好［35］。有研究报道了帕博利珠单抗治疗一例 PD-L1 表达阴性的 LCNEC 患者，疗效显著，提示即使 PD-L1 表达阴性，免疫检查点抑制剂对转移性 LCNEC 患者仍可能为一种有效的治疗选择［36］。
建议检测RB1和TP53，以明确进一步分型。
参考指南：
中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会 (CSCO) 小细胞肺癌诊疗指南2024.人民卫生出版社.北京 2024
中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会 (CSCO) 神经内分泌肿瘤诊疗指南2022.人民卫生出版社.北京 2022
中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会 (CSCO) 神经内分泌肿瘤诊疗指南2024.人民卫生出版社.北京 2024
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