Asamura Hisao, Kameya Toru, Matsuno Yoshihiro, Noguchi Masayuki, Tada Hirohito, Ishikawa Yuichi, Yokose Tomoyuki, Jiang Shi-Xu, Inoue Takeshi, Nakagawa Ken, Tajima Kinuko, Nagai Kanji
Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
J Clin Oncol. 2006 Jan 1;24(1):70-6. doi: 10.1200/JCO.2005.04.1202.
Neuroendocrine (NE) tumors of the lung include typical carcinoid (TC), atypical carcinoid (AC), large-cell NE carcinoma (LCNEC), and small-cell lung carcinoma (SCLC). Their clinicopathologic profiles and relative grade of malignancy have not been defined.
From 10 Japanese institutes, 383 surgically resected pulmonary NE tumors were collected. The histologic diagnosis was determined by the consensus of a pathology panel consisting of six expert pathologists as TC, AC, LCNEC, or SCLC on the basis of the WHO classification, and its relationship to clinicopathologic profiles was analyzed.
Of the 383 tumors, 18 were excluded because of an improper specimen. The pathology panel reviewed the remaining 366 tumors, and a diagnosis of NE tumor was made in 318 patients (87.4%); 55 patients had TC, nine had AC, 141 had LCNEC, and 113 had SCLC. The 5-year survival rates of patients with all stages were as follows: 96.2% for TC, 77.8% for AC, 40.3% for LCNEC, and 35.7% for SCLC. There was significant prognostic difference between TC and AC as well as between AC and LCNEC+SCLC. However, there was no difference between LCNEC and SCLC, and their survival curves were superimposed. The multivariate analysis indicated that histologic type, completeness of resection, symptoms, nodal involvement, and age were significantly prognostic.
The grade of malignancy of NE tumors was upgraded in the following order: TC, AC, LCNEC, and SCLC. No prognostic difference was noted between LCNEC and SCLC. The high-grade NE histology uniformly indicated poor prognosis regardless of its histologic type.
肺神经内分泌（NE）肿瘤包括典型类癌（TC）、非典型类癌（AC）、大细胞神经内分泌癌（LCNEC）和小细胞肺癌（SCLC）。它们的临床病理特征及相对恶性程度尚未明确。
从10家日本机构收集了383例手术切除的肺NE肿瘤。组织学诊断由6名专家病理学家组成的病理小组根据WHO分类达成共识确定为TC、AC、LCNEC或SCLC，并分析其与临床病理特征的关系。
383例肿瘤中，18例因标本不合格被排除。病理小组对其余366例肿瘤进行复查，318例患者（87.4%）被诊断为NE肿瘤；55例为TC，9例为AC，141例为LCNEC，113例为SCLC。各期患者的5年生存率如下：TC为96.2%，AC为77.8%，LCNEC为40.3%，SCLC为35.7%。TC与AC之间以及AC与LCNEC+SCLC之间存在显著的预后差异。然而，LCNEC与SCLC之间无差异，其生存曲线相互重叠。多因素分析表明，组织学类型、切除完整性、症状、淋巴结受累情况和年龄是显著的预后因素。
NE肿瘤的恶性程度按以下顺序升高：TC、AC、LCNEC、SCLC。LCNEC与SCLC之间未观察到预后差异。无论组织学类型如何，高级别NE组织学均提示预后不良。
