Differences In Clinical Characteristics Among Pulmonary Neuroendocrine Tumors And Possible Prognostic Value Of CgA, CD56, Syn Related Stain-patterns In Small Cell Lung Cancer

Objective: We analyze the differences in biological behaviors and neuroendocrinephenotypes between bronchopulmonary carcinoids and small cell lung cancer(SCLC),attempting to investigate if a subset of SCLC sharing neuroendocrine phenotypes thatmost expressed in cacinoids also share similar prognosis.Methods: The clinical data of16patients with BPC and40patients with SCLC,from January2007to June2013, were enrolled into retrospective analysis. Clinicalcharacteristics and immunohistochemical markers chromogranin A, CD56,Synaptopyhsin on basis of the pathology reports and their relationships between the2neuroendocrine tumors were analyzed. we categorized patients who were positive for all3markers as the triple-positive group and those who negative for1marker as thedouble-positive group,and who only positive for1marker as single-positive group.Results:1. For16BP carcinoids, the male-to-female ratio was1:3, and the averageage was (44±15) years. The average maximum diameter was (2.1±1.1) cm. Only1patient had lymph node metastasis. About11of all16cases (68.8%) were stage I,2were stage IIA,1was stage IIB,1were stage IIIA. The5-year progression free survivalrate were81.3%.For40SCLC,50%of the diameters were more than5cm.85%of thepatients had lymph node metastasis. Only9patients(22.5%) were early stage(Ⅰ-Ⅱ).Median progression free survival time were only8.6m.2.Positive rates of CgA (75%vs.25%, P<0.01) and distribution ofstainpatterns with neuroendocrine markers(P<0.05) showed significant differencesbetween BPC and SCLC. CD56，Syn showed no differences in expression.3.For SCLC，the univariate analysis revealed that advanced TNM staging(P=0.023), smoking status（P=0.041），tumor size（P=，0.039），LD/ED staging（P=0.000）are poor prognostic factors. Second, the survival rate was73%,83%,57%respectively in20cases underwent the radically surgical resection. Stratified analysisshowed stainpattern were prognostic factors in LD group.4.Multi-variate analysis revealed that TNM staging, tumor size and NEphenotypes were independent prognostic indicators.Conclusion:1.BPC and SCLC shows different biological behaviors. BPCs becomeless invasive and usually survive for a long time after surgery.2.NE phenotypes in relationship with CgA, CD56, Syn distribute indifference between BPC and SCLC. Tumors with neuroendocrine phenotypes most expressed in cacinoids also show better prognosis, especially in limited disease.The3-positive stain-pattern is an independent prognostic factor for a long PFS.3.TNM staging is better than LD/ED staging when we evaluateprogression free survival in SCLC.