Large cell neuroendocrine carcinoma: An aggressive form of non-small cell lung cancer
Large cell neuroendocrine carcinoma: An aggressive form of non-small cell lung cancer
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DOI：
10.1016/j.jtcvs.2005.02.064
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发表时间：
2005-07-01
影响因子：
6
通讯作者：
Patterson, GA
中科院分区：
文献类型：
--
作者：
Battafarano, RJ;Fernandez, FG;Patterson, GA
目的：肺大细胞神经内分泌癌的形态学和免疫组化特征与神经内分泌肿瘤和大细胞癌相同。大细胞神经内分泌癌的手术切除在许多系列中已有报道，5年生存率从13%到57%不等。关于这些肿瘤是否应该被分类和治疗为非小细胞肺癌或小细胞肺癌，已经出现了相当大的争论。本研究的目的是报告的结果与大细胞neuroendocrine carcinomas.Methods：我们的肿瘤登记进行了分析，以确定1988年7月1日至2002年12月31日，大细胞肿瘤手术切除肺癌的所有患者。然后根据形态和分化将病例分为大细胞神经内分泌癌、混合性大细胞神经内分泌癌（其中至少一部分肿瘤是大细胞神经内分泌癌）或大细胞癌。所有患者均完成随访，平均随访48个月。按分期分析切除类型、死亡率和生存率。所有患者的Kaplan-Meier生存率均从手术干预之日起测定。考克斯比例风险模型分析纳入年龄，性别，组织学，和阶段的变量估计大细胞神经内分泌癌和混合大细胞神经内分泌癌的复发和死亡的影响。根据1997年美国癌症联合委员会的guidelines.Results：在接受切除术的2099例患者中，82例（3.9%）有大细胞肺癌。围手术期死亡率为2.4%。整个组的5年总生存率和无复发率分别为47.1%和58.4%。大细胞神经内分泌癌患者（n = 45）、混合性大细胞神经内分泌癌患者（n = 11）和大细胞癌患者（n = 21）按组织学亚型分类的5年总生存率分别为30.2%、30.3%和71.3%。大细胞神经内分泌癌患者的生存率显著低于大细胞癌患者（P = 0.013）。标本中存在大细胞神经内分泌癌（大细胞神经内分泌癌和混合性大细胞神经内分泌癌组合并）与生存率降低显著相关。（相对危险度，2.44; 95%置信区间1.29-4.58; P =.003）和减少无复发率（相对危险度，4.52; 95%可信区间为1.76-11.57; P
Objective: Large cell neuroendocrine carcinomas of the lung display morphologic and immunohistochemical characteristics common to neuroendocrine tumors and the morphologic features of large cell carcinomas. Surgical resection of large cell neuroendocrine carcinomas in many series has been described, with 5-year actuarial survivals ranging from 13% to 57%. Considerable debate has emerged as to whether these tumors should be classified and treated as non-small cell lung cancers or small cell lung cancers. The objective of this study was to report the outcome of surgical resection in patients with large cell neuroendocrine carcinomas.Methods: An analysis of our tumor registry was performed to identify all patients undergoing surgical resection of lung cancer between July 1, 1988, and December 31, 2002, for large cell tumors. Cases were then segregated into large cell neuroendocrine carcinomas, mixed large cell neuroendocrine carcinomas (in which at least one portion of the tumor was a large cell neuroendocrine carcinoma), or large cell carcinomas on the basis of morphology and differentiation. Follow-up was complete on all patients, with a mean follow-up of 48 months. Type of resection, mortality, and survival by stage were analyzed. Kaplan-Meier survival was determined for all patients from the date of surgical intervention. Cox proportional hazards model analysis incorporating the variables of age, sex, histology, and stage estimated the effect of large cell neuroendocrine carcinomas and mixed large cell neuroendocrine carcinomas on recurrence and death. The stage of disease in all patients was assessed according to the 1997 American Joint Committee on Cancer guidelines.Results: Of the 2099 patients who underwent resection, 82 (3.9%) had large cell lung cancers. Perioperative mortality was 2.4%. Overall survival and freedom from recurrence at 5 years for the entire group was 47.1% and 58.4%, respectively. Overall survival by histologic subtype at 5 years was 30.2% for patients with large cell neuroendocrine carcinomas (n = 45), 30.3% for patients with mixed large cell neuroendocrine carcinomas (n 11), and 71.3% for patients with large cell carcinomas (n = 21). Survival was significantly worse for patients with large cell neuroendocrine carcinomas than for patients with large cell carcinomas (P =.013). The presence of large cell neuroendocrine carcinomas in the specimen (the large cell neuroendocrine carcinoma and mixed large cell neuroendocrine carcinoma groups combined) was significantly associated with decreased survival (relative risk, 2.44; 95% confidence interval 1.29-4.58; P =.003) and decreased freedom from recurrence (relative risk, 4.52; 95% confidence interval, 1.76-11.57; P