title: Large cell neuroendocrine carcinoma of the lung: pathological study and clinical outcome of 18 resected cases.
abstract: Large cell neuroendocrine carcinoma of the lung (LCNEC) has been recently redefined by the World Health Organisation (WHO) classification but the appropriate treatment remains unclear. We reviewed 18 consecutive resected cases of LCNEC. Two pathologists assessed diagnosis by applying rigorously the last WHO criteria. We reported the pathological features and the clinical outcome of this particular tumour. All patients were men with a median age of 63 years. Clinicopathologic stages corresponded to stage I (n = 8), II (n = 8) and IIIA (n = 2). All patients were treated as non-small cell lung carcinoma (NSCLC) and underwent surgery without any adjuvant treatment except four post-operative radiotherapy for N2 or T3 disease. The evolution was pejorative for 14 patients: one patient died of post-operative complications and 13 patients relapsed with distant metastases that occurred in 10 cases within 6 months after surgery. One-year survival rate was 27% and survival rate at the end of follow-up was 22%, which were both less than expected for stage-comparable NSCLC. Survival was neither influenced by lymph node status nor by pathological or molecular findings. Among the 10 evaluable patients with metastatic disease that received palliative platin-etoposide chemotherapy only two had partial tumour regressions (20%). Our study suggests that applying to LCNEC the NSCLC standard treatment lead to poor prognosis even in localised disease with a high incidence of early metastatic spread and a low response rate to chemotherapy. This way of relapse underlies the necessity of an efficient chemotherapy in order to improve survival.
authors.affiliation: Service de Pneumologie, Hôpital Rangueil, 31403 Toulouse Cedex, France. mazieres.j@chu-toulouse.fr
authors.forename: Julien
authors.initials: J
authors.lastname: Mazières
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Daste
authors.forename: Laurent
authors.initials: L
authors.lastname: Molinier
authors.forename: Jean
authors.initials: J
authors.lastname: Berjaud
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.forename: Martine
authors.initials: M
authors.lastname: Delsol
authors.forename: Pierre
authors.initials: P
authors.lastname: Carles
authors.forename: Alain
authors.initials: A
authors.lastname: Didier
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Bachaud
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018278:Carcinoma, Neuroendocrine / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D013534:Survival; D016896:Treatment Outcome