Large Cell Neuroendocrine Carcinoma of the Lung:Outcomes after Surgical Resection and Prognostic Factors

  Objective  To investigate the clinical manifestations, outcomes after surgical management, and prognostic factors of large cell neuroendocrine carcinoma (LCNEC) of the lung.

  Methods  We retrospectively analyzed the data of 35 consecutive cases (29 males, 6 females) of LCNEC of the lung surgically treated and pathologically confirmed in Peking Union Medical College Hospital from January 2000 to January 2014. Their outcomes after receiving surgery-based comprehensive therapy and related prognostic factors were explored.

  Results  The median age of patients was 63(47-77)years and the median duration of disease was 2(1-14)months. No specific symptom was found and preoperative pathological diagnosis was not definitive. Surgical methods included open or thoracoscopic lobectomy and lymph node dissection based on the specific conditions of tumor in each case. Postoperative pathological staging showed stage Ⅰ in 12 cases, stage Ⅱ in 7, stage Ⅲ in 13, and stage Ⅳ in 3. Twenty-three patients received adjuvant therapy. Median survival was 17 months95% confidence interval (CI):11.4-22.6 months. The 1-year, 3-year, and 5-year survival rates were 60.6%, 29.0%, and 24.8%, respectively. Tumor stage was significantly related with the overall survival (Cox regression analysis, hazard ration=2.608, 95% CI:1.572-4.327, P=0.000).

  Conclusions  LCNEC is a rare malignancy with tremendous aggressiveness and poor prognosis. Stage of tumor may be the independent risk factor affecting the prognosis. Surgery-based comprehensive therapy could achieve good survival for patients of early stages, especially stages Ⅰ and Ⅱ.