Original article: general thoracic
Large cell neuroendocrine carcinoma of the lung: an aggressive disease potentially treatable with surgery

https://doi.org/10.1016/j.athoracsur.2003.09.049Get rights and content

Abstract

Background

Assessment of clinical and pathologic features of large cell neuroendocrine carcinoma to confirm its specificity in the setting of high grade neuroendocrine pulmonary tumors.

Methods

From 1989 to 2001, 123 patients with a neuroendocrine carcinoma were surgically treated in a curative intent at a single institution. According to the 1999 World Health Organization classification, 20 patients were reviewed as having a large cell neuroendocrine carcinoma. Clinical data as well as detailed pathologic analysis and survival were collected.

Results

There were 18 men and 2 women. The median age was 62 years. Four patients had a preoperative diagnosis of large cell neuroendocrine carcinoma. The resections consisted of 14 lobectomies and 6 pneumonectomies. There was no operative death. Complications occurred in 7 patients (35%). Four patients had a stage I of the disease, 4 had stage II, 9 had stage III, and 3 had stage IV. At follow-up (median, 46 months), 13 patients died from general recurrence and 7 patients were still alive. Median time to progression was 9 months (range, 1 to 54 months). The 5-year survival rate was 36% (median, 49 months) and it seemed to be negatively influenced by the disease stage (54% for stage I-II vs 25% for stage III-IV; p = 0.07), the presence of metastatic lymph node (45% for N0/N1 vs 17% for N2; p = 0.12), or vessel invasion (66 vs 25%; p = 0.18).

Conclusions

Large cell neuroendocrine carcinoma predominantly occurred in men. An accurate tissue diagnosis was rarely obtained preoperatively. Although overall survival after resection was substantial, large cell neuroendocrine carcinoma frequently showed pathologic features of occult metastatic disease, such as lymph node or vessel invasion, or both.

Section snippets

Patients and methods

All neuroendocrine lung tumor specimens obtained between 1989 and 2001 (n = 123) were reclassified independently by two pathologists according to the new 1999 World Health Organization classification. We reviewed patients classified with LCNECs (neuroendocrine morphology and evidence of neuroendocrine differentiation by immunohistochemistry) who underwent an anatomical resection (ie, lobectomy and pneumonectomy) with a complete lymph node dissection (n = 20). We excluded specimens obtained

Results

There were 18 men and 2 women. Mean age was 62 years (range, 43 to 80 years). Ten patients were still smoking, whereas 7 were former and 3 were heavy smokers. Four patients were asymptomatic, their tumors being discovered incidentally on a chest roentgenogram. In the other 16 patients, the first symptoms were hemoptysis in 5, cough in 3, dyspnea in 2, fever in 1, pneumonia in 1, weigh loss in 1, and neurologic symptoms related to a solitary brain metastasis in 3. These 3 patients had operations

Comment

We conducted this study to assess clinical, surgical, and pathologic characteristics of LCNEC and to confirm its specificity in the setting of high grade neuroendocrine pulmonary tumors. We reported a higher proportion of men (90%) and the difficulty to obtain a pertinent preoperative pathologic diagnosis (20%). Furthermore, a high frequency of minimal mediastinal lymph node invasion (9 patients, 45%) was shown, whereas only 2 patients were considered as having preoperative N1 or N2 disease

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Copyright © 2004 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.