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J Thorac Cardiovasc Surg 2009;138:446-453
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Postoperative recurrence and the role of adjuvant chemotherapy in patients with pulmonary large-cell neuroendocrine carcinoma

Akira Iyoda, MD, PhDa,*, Kenzo Hiroshima, MD, PhDb, Yasumitsu Moriya, MD, PhDa, Yasuo Iwadate, MD, PhDc, Yuichi Takiguchi, MD, PhDd, Takashi Uno, MD, PhDe, Yukio Nakatani, MD, PhDb, Ichiro Yoshino, MD, PhDa

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
c Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
d Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
e Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan

Received for publication March 5, 2008; revisions received December 9, 2008; accepted for publication December 27, 2008.

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

Objectives: The prognosis for patients with large-cell neuroendocrine carcinoma is generally very poor. In this study, we describe the clinical features of recurrent tumors of large-cell neuroendocrine carcinoma and discuss the role of adjuvant chemotherapy and management of recurrence in patients with large-cell neuroendocrine carcinoma.

Methods: We retrospectively analyzed clinical data from 79 patients and evaluated the prognosis of patients with platinum-based adjuvant chemotherapy, recurrence patterns, patient response to chemotherapy or radiation therapy, and prognosis in patients who experienced relapse.

Results: Of 72 patients, 36 had confirmed recurrent tumors upon follow-up examinations. Of those with recurrent tumors, 33 patients (91.7%) had their first recurrent tumors within 3 years. Patients who underwent platinum-based adjuvant chemotherapy had a significantly lower rate of tumor recurrence and a higher rate of disease-free survival than those who had non–platinum-based adjuvant chemotherapy or no adjuvant chemotherapy. Multivariate analyses revealed that platinum-based adjuvant chemotherapy, pathologic stage, and the presence of second cancer are independent prognostic factors. Three patients with limited resection of the primary tumor had poor prognosis with recurrence. Postoperatively, 11 of the 36 patients without recurrence (30.6%) had metachronous second primary cancers, of which 4 patients had more than 1 site.

Conclusions: Patients with large-cell neuroendocrine carcinoma had frequent recurrence following resection of the primary tumor, and those without recurrence often developed metachronous second primary cancers. Platinum-based adjuvant chemotherapy after surgery may be useful for preventing recurrence in patients with large-cell neuroendocrine carcinoma.

Abbreviations and Acronyms CT = computed tomography; LCNEC = large-cell neuroendocrine carcinoma




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