Iyoda Akira, Hiroshima Kenzo, Moriya Yasumitsu, Iwadate Yasuo, Takiguchi Yuichi, Uno Takashi, Nakatani Yukio, Yoshino Ichiro
Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
J Thorac Cardiovasc Surg. 2009 Aug;138(2):446-53. doi: 10.1016/j.jtcvs.2008.12.037. Epub 2009 Mar 26.
The prognosis for patients with large-cell neuroendocrine carcinoma is generally very poor. In this study, we describe the clinical features of recurrent tumors of large-cell neuroendocrine carcinoma and discuss the role of adjuvant chemotherapy and management of recurrence in patients with large-cell neuroendocrine carcinoma.
We retrospectively analyzed clinical data from 79 patients and evaluated the prognosis of patients with platinum-based adjuvant chemotherapy, recurrence patterns, patient response to chemotherapy or radiation therapy, and prognosis in patients who experienced relapse.
Of 72 patients, 36 had confirmed recurrent tumors upon follow-up examinations. Of those with recurrent tumors, 33 patients (91.7%) had their first recurrent tumors within 3 years. Patients who underwent platinum-based adjuvant chemotherapy had a significantly lower rate of tumor recurrence and a higher rate of disease-free survival than those who had non-platinum-based adjuvant chemotherapy or no adjuvant chemotherapy. Multivariate analyses revealed that platinum-based adjuvant chemotherapy, pathologic stage, and the presence of second cancer are independent prognostic factors. Three patients with limited resection of the primary tumor had poor prognosis with recurrence. Postoperatively, 11 of the 36 patients without recurrence (30.6%) had metachronous second primary cancers, of which 4 patients had more than 1 site.
Patients with large-cell neuroendocrine carcinoma had frequent recurrence following resection of the primary tumor, and those without recurrence often developed metachronous second primary cancers. Platinum-based adjuvant chemotherapy after surgery may be useful for preventing recurrence in patients with large-cell neuroendocrine carcinoma.
大细胞神经内分泌癌患者的预后通常非常差。在本研究中，我们描述了大细胞神经内分泌癌复发性肿瘤的临床特征，并讨论辅助化疗的作用以及大细胞神经内分泌癌患者复发的管理。
我们回顾性分析了79例患者的临床资料，并评估了接受铂类辅助化疗患者的预后、复发模式、患者对化疗或放疗的反应以及复发患者的预后。
在72例患者中，36例在随访检查时确诊为复发性肿瘤。在这些复发性肿瘤患者中，33例（91.7%）在3年内出现首次复发性肿瘤。接受铂类辅助化疗的患者肿瘤复发率明显低于接受非铂类辅助化疗或未接受辅助化疗的患者，无病生存率更高。多因素分析显示，铂类辅助化疗、病理分期和第二原发癌的存在是独立的预后因素。3例原发肿瘤行有限切除的患者复发后预后较差。术后，36例未复发患者中有11例（30.6%）发生异时性第二原发癌，其中4例有1个以上部位。
大细胞神经内分泌癌患者原发肿瘤切除后复发频繁，未复发患者常发生异时性第二原发癌。术后铂类辅助化疗可能有助于预防大细胞神经内分泌癌患者的复发。
