Clinical Analysis Of 82 Cases Of Pulmonary Large-cell Neuroendocrine Carcinoma

[Objective]To explore the clinical features of pulmonary large-cell neuroendocrine carcinoma and analyze the prognostic factors.[Methods]Clinical data of 82 patients with pulmonary large-cell neuroendocrine carcinoma(LCNEC)treated in our hospital from May 2008 to May 2017 were retrospectively analyzed.[Results]The 5-year survival rate of 82 patients was 52%,69%in stage I(68%in stage IA and 71%in stage IB),38%in stage II(89%in stage IIA and 32%in stage IIB),43%in stage III(42%in stage IIIA and 33%in stage IIIB)?and 20%in stage IV.Tumor staging(stage IIIB/IV)was a poor prognostic factor for overall survival in univariate(p=0.001)and multivariate analysis(p=0.033).For 63 patients underwent R0 radical surgery,stage III,lymph node involvement and pneumonectomy were significantly associated with worse disease-free survival(DFS)in univariate analysis.K-ras mutation was a poor prognostic factor influencing DFS and overall survival in univariate and multivariate analysis.The prognosis of advanced LCNEC patients was poor.For recurrent patients after R0 radical surgery and de novo metastatic LCNEC receiving first-line platinum-based chemotherapy,the median progression free survival(PFS),overall survival and 1-year survival rate were 3.4-4.7 months,10.3-11.5 months and 36-38%,respectively.No significant differences in overall response rate,PFS and overall survival were observed between small cell carcinoma(SCLC)-regimens and non-small cell carcinoma(NSCLC)-regimens.[Conclusion]LCNEC is clinically heterogenous.The prognosis of early stage patients is similar to that of NSCLC.Advanced LCNEC is highly aggressive.The efficacy of SCLC-regimens is comparable to NSCLC-regimens for LCNEC patients both in the adjuvant and metastatic settings.