Akademik Veri Yönetim Sistemi
Medicina (Lithuania), cilt.62, sa.5, 2026 (SCI-Expanded, Scopus)
Background and Objectives: Pulmonary neuroendocrine carcinomas (NECs) are characterized by aggressive clinical behavior and heterogeneous postoperative outcomes. Early recurrence, often reflecting occult micrometastatic disease, remains a key determinant of prognosis and is insufficiently captured by conventional staging systems. We hypothesized that the lactate dehydrogenase-to-albumin ratio (LAR), as an integrative tumor–host biomarker, may provide biologically informed risk stratification in this setting. Materials and Methods: We conducted a multicenter retrospective cohort study including 88 patients with resected small cell lung cancer (SCLC) or large cell neuroendocrine carcinoma (LCNEC). Preoperative LAR and comparator inflammatory indices were evaluated. The primary endpoints were disease-free survival (DFS) and overall survival (OS), with early recurrence (≤12 months) as a prespecified secondary endpoint. Time-dependent receiver operating characteristic analyses, Cox proportional hazards models, and logistic regression analyses were applied within a predefined analytical framework. Results: Using a cut-off derived from 12-month DFS (LAR = 45.58), elevated LAR was associated with significantly shorter DFS (median 12.3 vs. 26.1 months; p = 0.018) and OS (median 20.7 vs. 52.8 months; p = 0.010). In multivariable analyses, LAR remained independently associated with both DFS (HR 1.012, 95% CI 1.001–1.023; p = 0.037) and OS (HR 1.016, 95% CI 1.005–1.027; p = 0.003). Elevated LAR was also associated with an increased risk of early recurrence (adjusted OR 4.656, 95% CI 1.520–14.262; p = 0.007). In time-dependent receiver operating characteristic (ROC) analyses, LAR demonstrated the highest overall discriminatory performance across evaluated biomarkers and showed a statistically significant advantage over neutrophil-to-lymphocyte ratio (NLR) for 24-month OS. Conclusions: Preoperative LAR captures a clinically relevant tumor–host phenotype associated with early disease progression and adverse survival outcomes in resected pulmonary NECs. As a biologically integrative and readily accessible biomarker, LAR may complement existing risk stratification strategies in this heterogeneous disease context. Prospective validation and integration into multimodal risk models are warranted.