Prognostic Landscape of Lymphoepithelial Carcinoma: Analysis of a National Database

TL;DR

This study analyzes survival factors for lymphoepithelial carcinoma using a national database, finding that age, cancer stage, and treatment significantly affect outcomes.

Contribution

The study provides a comprehensive analysis of prognostic factors for lymphoepithelial carcinoma using a large national database.

Findings

Advanced cancer stage and increasing age are strongly associated with higher mortality risk in LEC patients.

Lung LEC has the worst prognosis compared to LEC in other primary sites.

Chemotherapy is linked to improved survival, highlighting its importance in treatment.

Abstract

Objective: Lymphoepithelial carcinoma (LEC) is a rare and malignant epithelial tumor characterized by poorly differentiated carcinoma with lymphoplasmacytic infiltrate. This study utilizes the National Cancer Database (NCDB) to analyze demographic, clinical, and treatment factors affecting overall survival and evaluate the impact of treatment modalities and socioeconomic factors on outcomes.

Methods: Patients with LEC were identified in the NCDB between 2004 and 2020. Kaplan-Meier survival analysis, log-rank tests, and multivariable Cox proportional hazard models were used to assess the impact of variables such as age, tumor stage, Charlson-Deyo comorbidity score, adjuvant therapies, and socioeconomic factors.

Results: This study of 408 LEC patients identified several significant predictors of mortality. Advanced cancer stage (hazard ratio (HR): 8.45; 95% confidence interval (CI): 4.25-16.79; p < 0.001) and increasing age (per five years; HR: 1.20; 95% CI: 1.12-1.28; p < 0.001) were associated with increased mortality risk. Patients with lung LEC had worse survival than those with LEC in the female reproductive organs (HR: 0.35; 95% CI: 0.20-0.64; p < 0.001), while those with head and neck LEC had better survival rates than those with lung LEC (HR: 1.66; 95% CI: 1.04-2.67; p = 0.036). Chemotherapy was associated with improved survival (HR: 0.53; 95% CI: 0.30-0.96; p = 0.037). Socioeconomic status also played a role, with residence in the lowest educational attainment quartile associated with poorer survival (HR: 0.51; 95% CI: 0.26-0.98; p = 0.044) and private insurance coverage associated with better survival (HR: 1.97; 95% CI: 1.02-3.80; p = 0.042).

Conclusion: Older age, advanced stage, and low educational attainment are key predictors of poorer survival in LEC. Lymphoepithelial carcinoma has the worst prognosis when found in the lungs compared to any other primary site. Primary chemotherapy significantly improves survival, emphasizing its role in treatment. Further research is needed to explore cancer-specific mortality and the impact of site-specific differences.