title: Should large cell neuroendocrine lung carcinoma be classified and treated as a small cell lung cancer or with other large cell carcinomas?
abstract: BACKGROUND
  To compare the presenting and prognostic characteristics of patients with large cell neuroendocrine lung cancer (LCNELC) with those of patients with small cell lung cancer (SCLC) or other large cell carcinomas (OLCs) and to compare overall survival (OS) and lung cancer-specific survival (LCSS) rates for patients undergoing definitive resection without radiotherapy (S-NoRT).
  
  
  METHODS
  The Surveillance Epidemiology and End Results Database-17 from 2001 to 2007 was used. Differences between population characteristics were compared using χ(2) and Wilcoxon tests. The log-rank test and Cox models were used to compare differences in OS and LCSS.
  
  
  RESULTS
  There were 1211 patients with LCNELC (324 in the S-NoRT group), 8295 patients with OLC (1120 S-NoRT), and 35,304 patients with SCLC (355 S-NoRT). The proportion of all large cell carcinomas constituted by LCNELC increased from 8 to 21% during the study period; and the proportion of patients with large cell carcinoma undergoing S-NoRT increased from 16 to 26%. Presenting and histopathologic characteristics and treatment factors of patients undergoing S-NoRT for patients with LCNELC were more similar to those of patients with OLC than to those with SCLC. OS and LCSS rates for patients with LCNELC undergoing resection without radiation were similar to those of patients with OLC and better than those for patients with SCLC, but the differences were not statistically significant on multivariate analysis.
  
  
  CONCLUSIONS
  The clinical, histopathologic, and biologic features of LCNELC are more similar to OLC than to SCLC. Therefore, LCNELC should continue to be classified and treated as a large cell carcinoma.
authors.affiliation: Division of Radiation Oncology, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA. jvarlotto@hmc.psu.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Varlotto
authors.forename: Laura Nyshel
authors.initials: LN
authors.lastname: Medford-Davis
authors.forename: Abram
authors.initials: A
authors.lastname: Recht
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: Eric
authors.initials: E
authors.lastname: Schaefer
authors.forename: Dani S
authors.initials: DS
authors.lastname: Zander
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
mesh_terms: D000368:Aged; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome