title: Large cell neuroendocrine carcinoma of the lung: an aggressive disease potentially treatable with surgery.
abstract: BACKGROUND
  Assessment of clinical and pathologic features of large cell neuroendocrine carcinoma to confirm its specificity in the setting of high grade neuroendocrine pulmonary tumors.
  
  
  METHODS
  From 1989 to 2001, 123 patients with a neuroendocrine carcinoma were surgically treated in a curative intent at a single institution. According to the 1999 World Health Organization classification, 20 patients were reviewed as having a large cell neuroendocrine carcinoma. Clinical data as well as detailed pathologic analysis and survival were collected.
  
  
  RESULTS
  There were 18 men and 2 women. The median age was 62 years. Four patients had a preoperative diagnosis of large cell neuroendocrine carcinoma. The resections consisted of 14 lobectomies and 6 pneumonectomies. There was no operative death. Complications occurred in 7 patients (35%). Four patients had a stage I of the disease, 4 had stage II, 9 had stage III, and 3 had stage IV. At follow-up (median, 46 months), 13 patients died from general recurrence and 7 patients were still alive. Median time to progression was 9 months (range, 1 to 54 months). The 5-year survival rate was 36% (median, 49 months) and it seemed to be negatively influenced by the disease stage (54% for stage I-II vs 25% for stage III-IV; p = 0.07), the presence of metastatic lymph node (45% for N0/N1 vs 17% for N2; p = 0.12), or vessel invasion (66 vs 25%; p = 0.18).
  
  
  CONCLUSIONS
  Large cell neuroendocrine carcinoma predominantly occurred in men. An accurate tissue diagnosis was rarely obtained preoperatively. Although overall survival after resection was substantial, large cell neuroendocrine carcinoma frequently showed pathologic features of occult metastatic disease, such as lymph node or vessel invasion, or both.
authors.affiliation: Department of Thoracic Surgery, Université de la Méditerranée (Aix-Marseille II), Faculty of Medicine, Sainte-Marguerite Hospital, France. christophe.doddoli@mail.ap-hm.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Fabrice
authors.initials: F
authors.lastname: Barlesi
authors.forename: Bruno
authors.initials: B
authors.lastname: Chetaille
authors.forename: Louise
authors.initials: L
authors.lastname: Garbe
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Roger
authors.initials: R
authors.lastname: Giudicelli
authors.forename: Pierre
authors.initials: P
authors.lastname: Fuentes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate