Clinical-pathologic analysis of 40 patients with large cell neuroendocrine carcinoma of the lung

Background. The identification, classification, and appropriate treatment of patients with pulmonary carcinomas demonstrating neuroendocrine differentiation remains controversial. Methods. Patients undergoing resection of lung cancer at Washington University since 1986 were reviewed to identify all large cell neuroendocrine carcinomas. Cases were segregated into large, small, or mixed cell categories, and graded as moderate ('atypical carcinoid') or poorly differentiated (all higher grade lesions). All patients' charts were reviewed and referring physicians contacted to ascertain cancer treatment after resection and follow-up status. Results. Forty patients were identified with large cell neuroendocrine carcinoma: 8 moderate and 32 high-grade. Average follow-up was 19.8 months. Stage distribution was as follows: I, 25; II, 6; III, 6; and VI, 3. Fifteen patients have no evidence of disease, 15 are dead of disease, and 6 are alive with disease. Five-year survival of the stage I patients is 18%; all-stage 5-year survival is 13%. Of the 15 patients who died of their disease, 80% had stage I or II disease. Postoperative chemotherapy, radiation therapy, or both were given to 9 of 26 patient in stage I, with six deaths (67%). Six of 17 patients (35%) with stage I disease died after no postoperative intervention. Conclusions. Large cell neuroendocrine carcinomas identified by histologic examination have a remarkably poor prognosis even in very early stage disease. Adjuvant therapy did not improve survival.