Zacharias Joseph, Nicholson Andrew G, Ladas George P, Goldstraw Peter
Department of Thoracic Surgery and Histopathology, Royal Brompton Hospital, London, United Kingdom.
Ann Thorac Surg. 2003 Feb;75(2):348-52. doi: 10.1016/s0003-4975(02)04118-8.
Large cell neuroendocrine carcinoma (LCNEC) and large cell carcinoma with neuroendocrine morphology of the lung are both currently classified as subtypes of large cell carcinomas according to the World Health Organization IASLC classification system for lung and pleural tumors. Prognosis is reported as similar to that of small cell carcinomas. There is no consensus on management of this subset and adjuvant chemotherapy is recommended by some for early stage LCNEC to impact long-term prognosis. We retrospectively reviewed a cohort of patients at our institution who had this type of tumor to determine factors that might influence survival.
Twenty-one cases of LCNEC and large cell carcinoma with neuroendocrine morphology were identified in the files of the Royal Brompton Hospital between 1986 and 1999. All patient data were reviewed, and complete follow-up was achieved with 20 of these patients.
Of the 21 patients identified, 20 underwent resection with systematic nodal dissection in 18. There was no in-hospital mortality. Of those patients fully staged by systematic nodal dissection, 9 were stage I, 5 were stage II and 4 were stage III. Median follow-up was 25 months (range, 2 to 120 months). At the time of review, 11 patients were alive and free of disease. One patient was alive and free of disease when lost to follow-up. Nine patients had died, 7 related and 2 unrelated to disease. The 5-year actuarial survival for the entire group was 47%. The actuarial survival of accurately staged, stage I patients at 5 years was 88%. The actuarial survival of patients in stage II and III was 28% at 5 years.
LCNEC and large cell carcinoma with neuroendocrine morphology are aggressive tumors, but patients with completely resected disease after systematic nodal dissection have a better prognosis than previously described. Patients with more advanced disease have a poor prognosis.
根据世界卫生组织国际肺癌研究协会（IASLC）的肺和胸膜肿瘤分类系统，大细胞神经内分泌癌（LCNEC）和具有神经内分泌形态的肺大细胞癌目前均被归类为大细胞癌的亚型。据报道，其预后与小细胞癌相似。对于这一亚组的治疗尚无共识，一些人建议对早期LCNEC进行辅助化疗以影响长期预后。我们回顾性分析了我院一组患有此类肿瘤的患者，以确定可能影响生存的因素。
在皇家布朗普顿医院1986年至1999年的档案中，共识别出21例LCNEC和具有神经内分泌形态的大细胞癌患者。对所有患者的数据进行了回顾，并对其中20例患者进行了完整的随访。
在识别出的21例患者中，20例接受了手术切除，其中18例进行了系统性淋巴结清扫。无院内死亡病例。在通过系统性淋巴结清扫进行全面分期的患者中，9例为I期，5例为II期，4例为III期。中位随访时间为25个月（范围为2至120个月）。在复查时，11例患者存活且无疾病。1例患者在失访时存活且无疾病。9例患者死亡，其中7例与疾病相关，2例与疾病无关。整个组的5年精算生存率为47%。准确分期的I期患者5年精算生存率为88%。II期和III期患者5年精算生存率为28%。
LCNEC和具有神经内分泌形态的大细胞癌是侵袭性肿瘤，但经过系统性淋巴结清扫后完全切除疾病的患者预后比之前描述的要好。疾病分期较晚的患者预后较差。
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