Treatment And Prognosis Of Pulmonary Large Cell Neuroendocrine Carcinoma

[Objects] This article was to summarize the clinical character of the pulmonary large cell neuroendocrine carcinoma (LCNEC), analyze the factors related to prognosis, and explore better treatment of LCNEC.[Methods] The data of a total of 41 pathologically confirmed LCNEC patients from January 1999 to March 2013 in Cancer Hospital was collected by review of medical records and telephone follow-up and was retrospectively analyzed. The survival analysis was evaluated using the method of Kaplan and Meier by SPSS 19.0 software. The log-rank test was used for univariate survival analysis and Cox regression was used for multivariate analysis. Chi-square test was used to compare difference in recurrence rate.[Results] There were 38 male patients in all 41 cases, comparing with only 3 female patients. The average age of patients was 65.5 years old. There were 36 cases who had heavy smoking history with the mean smoking index 715 stick-years. None of 41 cases was diagnosed before surgery. N stage was the important relevant prognostic factor by univariate analysis (P=0.048) and multivariate analysis (-P=0.019). The 5-year relapse-free survival rate was 68.4% in comprehensive treatment group who accepted surgery and adjuvant chemotherapy and 28.2% in surgery alone group, which had significant statistic difference (P=0.043). The overall survival rate of relapsed patients who adopted salvage therapy was 66.7%, while the overall survival rate of the patients who did not accept retreatment was only 11.1%(P=0.039).[Conclusions] LCNEC more likely happens in old male patients with heavy smoking and preoperative diagnosis is difficult. The pathology result after surgery is needed for definitive diagnosis. N stage is obviously related to the prognosis of LCNEC. Comprehensive treatments including surgery and platinum-based adjuvant chemotherapy can prolong the relapse-free survival time and reduce recurrence rate of LCNEC patients. The retreatment of chemotherapy and (or) radiotherapy can further improve the long-term survival in relapsed patients of LCNEC.