Sutanto Leone, Cheung Ka Man, Chow Chung Hang James, Yiu Ho Yin Harry
Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, HKG.
Cureus. 2025 Jun 24;17(6):e86698. doi: 10.7759/cureus.86698. eCollection 2025 Jun.
Introduction Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive form of lung cancer. Given its poor prognosis and limited representation in clinical trials, the optimal treatment strategy remains undefined. This study aims to evaluate treatment modalities and clinical outcomes among LCNEC patients who received definitive treatment. Methods A retrospective review was conducted for patients diagnosed with LCNEC from 2000 to 2022 in a tertiary center. Clinical characteristics, staging, treatment modalities, molecular testing, and survival outcomes were collected. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier estimates. Results Twenty-seven patients were included. The median age was 69.6 years; most were male (92.6%) and smokers (92.6%). Distribution by stage was as follows: I (29.6%), II (22.2%), and III (48.1%). Surgery was performed in 77.8%, and 33.3% received chemoradiotherapy. Adjuvant platinum-etoposide chemotherapy was administered in 42.8% of surgical cases. With a median follow-up of 75.9 months, the median PFS and OS were 9.6 and 20.8 months, respectively. The median OS by stage was as follows: I (30.2 months), II (23.5 months), and III (14.9 months). The recurrence rate was high (85.2%), with distant relapse being the most common (63%). Locoregional control was achieved in 40.7% of patients. Actionable mutations were detected in one patient (3.7%), and comprehensive molecular testing was underutilized. Conclusion LCNEC remains a clinically aggressive tumor with poor outcomes despite definitive treatment. The high recurrence rate, particularly in advanced stages, highlights the need for improved systemic strategies. Broader adoption of molecular profiling may uncover therapeutic targets and support the integration of emerging treatments, including immunotherapy.
引言 肺大细胞神经内分泌癌（LCNEC）是一种罕见且侵袭性强的肺癌形式。鉴于其预后较差且在临床试验中的代表性有限，最佳治疗策略仍不明确。本研究旨在评估接受确定性治疗的LCNEC患者的治疗方式和临床结局。方法 对2000年至2022年在一家三级中心诊断为LCNEC的患者进行回顾性研究。收集临床特征、分期、治疗方式、分子检测和生存结局。采用Kaplan-Meier估计法分析无进展生存期（PFS）和总生存期（OS）。结果 纳入27例患者。中位年龄为69.6岁；大多数为男性（92.6%）且为吸烟者（92.6%）。按分期分布如下：I期（29.6%）、II期（22.2%）和III期（48.1%）。77.8%的患者接受了手术，33.3%的患者接受了放化疗。42.8%的手术病例接受了辅助铂类-依托泊苷化疗。中位随访75.9个月，中位PFS和OS分别为9.6个月和20.8个月。各期的中位OS如下：I期（30.2个月）、II期（23.5个月）和III期（14.9个月）。复发率较高（85.2%），远处复发最为常见（63%）。40.7%的患者实现了局部区域控制。1例患者（3.7%）检测到可操作的突变，综合分子检测未得到充分利用。结论 尽管进行了确定性治疗，LCNEC仍是一种临床侵袭性肿瘤，预后较差。高复发率，尤其是在晚期，凸显了改进全身治疗策略的必要性。更广泛地采用分子谱分析可能会发现治疗靶点，并支持包括免疫治疗在内的新兴治疗方法的整合。
