Abstract: Pulmonary large-cell neuroendocrine carcinoma (LCNEC), first reported in 1991, is a rare pulmonary epithelial malignancy. It was not until 2004 that LCNEC was officially classified pathologically as the bronchopulmonary neuroendocrine tumor. Most of the patients are elderly male smokers. Their clinical manifestations are not specific. They may have respiratory tract-related symptoms. Paraneoplastic syndrome is rare. CT usually shows peripheral nodules, including lobulation, burr, and pleural traction. LCNEC was reported as a highly aggressive malignancy, with lymph node metastasis occurring in about 60%-80% of patients and distant metastasis in about 40% of patients, similar to the degree of malignancy of small cell lung cancer. Surgery combined with postoperative adjuvant therapy is the main treatment for stage Ⅰ, Ⅱ, and Ⅲa patients. PE regimen is recommended for chemotherapy. Metastasis and recurrence may be the main causes of poor prognosis. Tumor-driven genes and targeted drug therapy need further study.