Clinical analysis of 50 Eastern Asian patients with primary pulmonary large-cell neuroendocrine carcinoma

Abstract

BackgroundTo understand the clinicopathological features of patients with primary pulmonary large-cell neuroendocrine carcinoma (LCNEC), including the frequency of epidermal growth factor receptor (EGFR) mutation, and to explore prognostic factors.MethodsWe investigated a cohort of 50 individuals from our center database who were diagnosed with operable pulmonary LCNEC and treated in Sun Yat-sen University Cancer Center. Serum albumin (ALB) and neuron-specific enolase (NSE) were also collected. Survival curves were obtained with the Kaplan–Meier method, and the differences between groups in survival were tested by the log-rank test.ResultsThe median age was 59 years (range, 40–80 years). Fourteen patients underwent mutational analysis of EGFR; of these, 12 had wild-type EGFR and the remaining two had EGFR mutations in exons. The median disease-free survival (DFS) of pulmonary LCNEC was 49.3 months and that of overall survival (OS) was not reached. DFS and OS were shorter for patients with decreased serum ALB than for patients with normal serum ALB (P=0.003 and P=0.004, respectively). Meanwhile, a high level of NSE was also significantly associated with short DFS and OS (P=0.005 and P=0.000, respectively). Multivariate analysis showed that decrease in serum ALB was an independent prognostic factor for OS (P=0.046).ConclusionThe frequency of EGFR mutation in LCNEC patients is low. Serum ALB and NSE levels are valuable prognostic factors for LCNEC patients.

Recurrence-Free Survival in Early and Locally Advanced Large Cell Neuroendocrine Carcinoma of the Lung after Complete Tumor Resection

“…Due to its low frequency, data related to early-stage LCNEC derived only from a relatively low number of studies [ 6 , 7 , 9 , 14 , 15 , 16 , 19 ], which included heterogeneous cohorts of patients having also patients with advanced diseases or who did not undergo tumor resection, or with a diagnosis of combined-LCNEC at histopathological analysis. Studies including only early and locally advanced LCNEC after complete resection of the tumor are very few [ 21 , 22 , 23 , 24 ] and focused mostly on overall survival ( Table 1 ). Only the study by Zhang et al [ 23 ] reported a median RFS of 49.3 months.…”

“…Studies including only early and locally advanced LCNEC after complete resection of the tumor are very few [ 21 , 22 , 23 , 24 ] and focused mostly on overall survival ( Table 1 ). Only the study by Zhang et al [ 23 ] reported a median RFS of 49.3 months. In addition, median follow-up ranged between 24.9 and 47 months in only two studies [ 21 , 22 ] ( Table 1 ).…”

“…The study by Casali et al [ 22 ], as well as that by Zhang et al [ 23 ], failed to find prognostic markers of RFS. Casali et al showed that c-kit protein-positive immunostaining represented a negative prognostic factor of OS [ 22 ].…”

“…However, all these above-mentioned studies also included patients with not-complete LCNEC resection, histological diagnosis of mixed type of LCNEC, as well a very small percentage of patients with advanced diseases. Only four studies, summarized in Table 1 , evaluated patients with early and locally advanced LCNEC after complete tumor resection (R0) and with histological diagnosis of pure LCNEC [ 21 , 22 , 23 , 24 ].…”

“…Particularly, one study reported a median RFS of 49 months [ 23 ]. The other three studies showed a 5-year OS rate ranging between 47% and 51% [ 21 , 22 , 24 ].…”