Elsevier

The Annals of Thoracic Surgery

Volume 82, Issue 5, November 2006, Pages 1802-1807
The Annals of Thoracic Surgery

Original article
General thoracic
Prospective Study of Adjuvant Chemotherapy for Pulmonary Large Cell Neuroendocrine Carcinoma

https://doi.org/10.1016/j.athoracsur.2006.05.109Get rights and content

Background

Patients with pulmonary large cell neuroendocrine carcinoma (LCNEC) have a very poor prognosis, but the benefit of adjuvant chemotherapy for these patients has not been established. We performed a prospective analysis of adjuvant chemotherapy for patients with completely resected pulmonary LCNECs to assess the effect of adjuvant chemotherapy.

Methods

The adjuvant mixture consisted of cisplatin and VP-16 and was administered after surgery to 15 patients with LCNECs from 2000 to 2005. We compared patient survival with historical data for LCNEC patients treated without platinum-based adjuvant chemotherapy after surgery.

Results

There were no differences in age, gender, surgical methods, and staging between the adjuvant chemotherapy group and the control group. Median follow-up was 33 months for the adjuvant group and 42 months for the control group. Of the 15 patients in the adjuvant chemotherapy group, 2 patients had disease recurrence and 1 died of interstitial pneumonia. The overall survival rate at 2 and 5 years of patients with adjuvant chemotherapy was 88.9%. The overall survival rate between patients with adjuvant chemotherapy and the historical control group was significantly different.

Conclusions

Adjuvant chemotherapy consisting of cisplatin and VP-16 after surgery appears promising for the improvement of the prognosis for patients with completely resected LCNECs, and it should be evaluated further in larger multi-institutional trials.

Section snippets

Patients and Methods

The study was a one-arm, nonrandomized clinical study of primary pulmonary LCNEC patients whose tumors were resected surgically at Chiba University Hospital and Chiba Cancer Center between October 2000 and April 2005. LCNEC has evidence of neuroendocrine differentiation detected by immunohistochemistry or electron microscopy and the following neuroendocrine morphologic features: (1) neuroendocrine morphology such as organoid nesting, palisading, rosettes, and trabeculae; (2) a high mitotic rate

Results

Between October 2000 and April 2005, we treated 22 patients with LCNEC. Of these, 7 patients were excluded from the study because of incomplete resection, renal dysfunction, early recurrence, or no informed consents. In the prospective arm, therefore, 15 men with LCNEC were enrolled in the adjuvant chemotherapy group. These patients received a lobectomy with lymph node dissection followed by adjuvant chemotherapy consisting of CDDP and VP-16. Thirteen of the study subjects completed 2 courses

Comment

In general, the curative treatment for patients with non-SCLC is surgical resection. Pelosi and colleagues [9], however, reported that stage 1 adenocarcinomas with neuroendocrine differentiation were clinically aggressive tumors, and Hiroshima and colleagues [10] reported that stage 1 adenocarcinomas with neuroendocrine differentiation had a particularly poor prognosis. Previously, we reported [3] that patients with LCNEC features had a significantly poorer prognosis than patients with classic

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