Pulmonary large cell neuroendocrine carcinoma (LCNC) is an uncommon high-grade neuroendocrine tumour sharing several biological features with small-cell lung carcinoma(SCLC). Patients with LCNC, even in Stage I, are more likely to develop recurrences and have a poor survival. Aim of this study is to evaluate factors influencing survival in this rare group of lung cancer.
From 1/1998 to 12/2008 31patients (23 males, 74.2%-mean age 67 years, range 53–80 years-) were operated on for LCNC at our Department.
Radical resection was achieved in all; wedge/segmental resection was performed in 8(25.8%), lobectomy in 19(61.3%) and pneumonectomy in 4(12.9%) patients. Mean tumour size was 3.7 cm(range1–10 cm); 23 tumours (74.2%) were T2, 7 T1 and 1 T3 (chest wall invasion); 21 lesions (67.7%) were N0,6 N1 and 4 N2. Fifteen patients received postoperative adjuvant chemotherapy (platinum-etoposide-based chemotherapy). Tumour recurrences (7 local recurrences) developed in 12 patients(38.7%); mean recurrence appearance time after surgery was 18 months (range 11–31 months). Overall 1,3 and 5-year survival rates were 83%, 22%, and 11%. Three and 5-year survival rates in Stage I patients were 43% and 18%; no Stage II patient survived longer than 2 years. Patients receiving adjuvant chemotherapy survived longer than the others (p = 0.002): their 3 and 5-year survival rates were 82% and 41%, respectively. In multivariate analysis, a tumour size > 4 centimeters (OR 0.227, 95% CI 0.0003375–8.634, p = 0.002), a non-anatomic surgical resection (OR 11.78, 95% CI 1.897–732.179, p = 0.005), the presence of T2-T3 tumour(OR 82468.167, 95% CI 0.01327–5132798.986, p = 0.001), the presence of lymph nodal metastases (OR 0.11, 95% CI 0.000000172–365.723, p = 0.002), the presence of visceral pleura invasion (OR 0.11, 95% CI 0.06–1.567, p = 0.0005) and the presence of tumour recurrence (OR 536.57, 95% CI 0.0023–1213.93, p = 0.002), were significant negative prognostic factors. Postoperative adjuvant chemotherapy (OR 126.886, 95% CI 0.12998–148631.9802, p = 0.002) resulted a significative important positive prognostic factor.
LCNC represents an aggressive tumour requiring a multimodal treatment(surgery plus adjuvant chemotherapy)even for resectable Stage I disease.Patients who receive anatomic resection followed by platinum-etoposide-based chemotherapy have the best survival.
LCNC must be treated by an aggressive multimodal way,the only who can improve patient survival.
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