CLINICAL-PATHOLOGICAL ANALYSIS OF 40 PATIENTS WITH LARGE-CELL NEUROENDOCRINE CARCINOMA OF THE LUNG

Background. The identification, classification, and appropriate treatm ent of patients with pulmonary carcinomas demonstrating neuroendocrine differentiation remains controversial. Methods. Patients undergoing r esection of lung cancer at Washington University since 1986 were revie wed to identify all large cell neuroendocrine carcinomas. Cases were s egregated into large, small, or mixed cell categories, and graded as m oderate (''atypical carcinoid'') or poorly differentiated (all higher grade lesions). All patients' charts were reviewed and referring physi cians contacted to ascertain cancer treatment after resection and foll ow-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 ar e 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. C onclusions. Large cell neuroendocrine carcinomas identified by histolo gic examination have a remarkably poor prognosis even in very early st age disease. Adjuvant therapy did not improve survival. (C) 1997 by Th e Society of Thoracic Surgeons