title: Prognostic impact of nestin expression in resected large cell neuroendocrine carcinoma of the lung.
abstract: BACKGROUND
  Large cell neuroendocrine carcinoma (LCNEC) of the lung is categorized as a high-grade neuroendocrine carcinoma with an aggressive clinical behavior. Nestin is a class VI intermediate filament protein expressed in stem/progenitor cells during central nervous system development. Recently, we reported that nestin expression is a prognostic indicator of a poorer survival probability in patients with resected NSCLC. In the present study, we aimed to determine its prognostic significance concerning survival in patients with resected LCNEC.
  
  
  METHODS
  Nestin expression in tumor cells was immunohistochemically studied in 30 patients with resected LCNEC, and its associations with clinicopathologic parameters including the Ki-67 labeling index (LI) and TTF-1 expression were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of nestin expression on survival.
  
  
  RESULTS
  Nestin expression was observed in 8 of the 30 (26.7%) LCNECs. Clinicopathologically, although no significant association between nestin expression and age, gender, smoking habits, p-TNM stage, tumor size, nodal status, or TTF-1 expression was observed, nestin expression was significantly associated with a high Ki-67 LI (P=0.012). On survival analysis, nestin expression was significantly associated with a poorer prognosis in patients with LCNEC (P=0.016). The Cox proportional regression model confirmed that the crude hazard ratio (95%CI) of nestin expression was 3.40 (1.18-9.77).
  
  
  CONCLUSIONS
  The present study suggests that nestin expression seems to be a prognostic indicator of a poorer survival probability in patients with resected LCNEC, although its prognostic significance still requires confirmation with larger patient populations.
authors.affiliation: Department of Respiratory Medicine, School of Medicine, Kanagawa, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Ryuge
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Shi Xu
authors.initials: SX
authors.lastname: Jiang
authors.forename: Guoqin
authors.initials: G
authors.lastname: Wang
authors.forename: Toshihide
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Ken
authors.initials: K
authors.lastname: Katono
authors.forename: Hayato
authors.initials: H
authors.lastname: Inoue
authors.forename: Akira
authors.initials: A
authors.lastname: Iyoda
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Satoh
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Masuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D018278:Carcinoma, Neuroendocrine / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007381:Intermediate Filament Proteins / Q000235:genetics*; D008175:Lung Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009419:Nerve Tissue Proteins / Q000235:genetics*; D064231:Nestin; D011379:Prognosis
chemical_list: D007381:Intermediate Filament Proteins; C577484:NES protein, human; D009419:Nerve Tissue Proteins; D064231:Nestin