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J Thorac Cardiovasc Surg 2006;132:312-315
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Prognostic impact of large cell neuroendocrine histology in patients with pathologic stage Ia pulmonary non–small cell carcinoma

Akira Iyoda, MD a , * , Kenzo Hiroshima, MD b , Yasumitsu Moriya, MD a , Yasuo Sekine, MD a , Kiyoshi Shibuya, MD a , Toshihiko Iizasa, MD a , Yukio Nakatani, MD b , Takehiko Fujisawa, MD a

a Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
b Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan.

Received for publication November 30, 2005; revisions received February 9, 2006; accepted for publication February 21, 2006.

* Address for reprints: Akira Iyoda, MD, Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan (Email: aiyoda{at}faculty.chiba-u.jp).

BACKGROUND: Most patients with pathologic stage Ia non–small cell lung carcinoma have a good prognosis, and adjuvant chemotherapy is currently not being used in the management of this stage of the disease. However, if significant negative prognostic factors become evident in patients with pathologic stage Ia non–small cell lung carcinoma, patients with negative prognostic factors should have adjuvant treatment after surgery.

METHODS: We analyzed 335 cases of pathologic stage Ia non–small cell lung carcinoma treated between 1988 and 2003 by complete resection. The pathologic stage Ia non–small cell lung carcinomas comprised 259 adenocarcinomas, 65 squamous cell carcinomas, and 11 large cell neuroendocrine carcinomas. The prognostic impact of various clinical variables was investigated by the Cox proportional hazards multivariable regression model.

RESULTS: Univariate analysis showed that large cell neuroendocrine carcinoma histology, old age, large tumor size, male gender, and smoking predicted poorer overall survival. Large cell neuroendocrine carcinoma had a significantly poorer prognosis than other non–small cell carcinomas. Multivariate analysis revealed that large cell neuroendocrine carcinoma was predictive of poorer overall survival (P = .0200, hazard ratio 2.787).

CONCLUSIONS: Large cell neuroendocrine histology has a significant adverse prognostic impact on pathologic stage Ia non–small cell carcinoma. Therefore, surgical resection alone represents insufficient treatment for large cell neuroendocrine carcinoma, even for pathologic stage Ia disease.

Abbreviations and Acronyms LCNEC = large cell neuroendocrine carcinoma; NSCLC = non–small cell lung carcinoma




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Home page
 Ann. Thorac. Surg.Home page
A. Iyoda, K. Hiroshima, Y. Nakatani, and T. Fujisawa
Pulmonary Large Cell Neuroendocrine Carcinoma: Its Place in the Spectrum of Pulmonary Carcinoma
Ann. Thorac. Surg., August 1, 2007; 84(2): 702 - 707.
[Abstract] [Full Text] [PDF]


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