Prognostic features of large cell anaplastic carcinoma of the bronchus

Results of surgical resection for patients with large cell carcinoma of the lung

PURPOSE

The clinical features of large cell carcinoma (LCC) of the lung have remained unclear due to the low incidence of the disease. This study investigated the clinicopathological features and the surgical outcome in patients with LCC.

SUBJECTS

This study clinicopathologically evaluated 975 patients who had undergone a resection for non-small cell carcinoma between 1994 and 2007. There were 57 (5.8%) patients with LCC among them.

RESULTS

The LCC patients included 49 males and 8 females and included 9 patients with large cell neuroendocrine carcinoma. All patients excluding 1 had a smoking habit. The mean smoking pack-year index was 49.9 in the patients with LCC, 27.1 in 625 patients with adenocarcinoma, and 52.5 in 266 patients with squamous cell carcinoma, and this was significantly higher in the patients with LCC than in those with adenocarcinoma. The mean tumor diameter was 38 mm for LCC, 28 mm for adenocarcinoma, and 39 mm for squamous cell carcinoma. The pathological stage was IA in 11 patients, IB in 11, II in 12, IIIA in 16, IIIB in 5, and IV in 2. The post-operative 5-year survival rate was 60.5% for LCC, 64.3% for large cell neuroendocrine carcinoma, 67.0% for adenocarcinoma, and 50.1% for squamous cell carcinoma.

CONCLUSION

The tumor diameter was significantly larger for LCC than for adenocarcinoma at the time of diagnosis. The proportion of smokers and the smoking pack-year index in patients with LCC were significantly higher than those of adenocarcinoma. The surgical results were similar between LCC and other non-small cell lung carcinomas.

Clinical features of bronchogenic large cell carcinoma confirmed by surgical resection

BACKGROUND

To define the final outcome of large cell carcinomas (LCC) after surgical treatment, the histopathology, clinical features and follow-up results of 28 cases were reviewed.

METHODS

Twenty eight patients, with LCC that underwent a surgical resection between 1986 and 2001, at the Severance Hospital, were retrospectively reviewed. We analyzed clinical data, radiological findings, pathologic findings, treatment modalities, and survival.

RESULTS

The prevalence of LCC was 2.9% (29 cases) among the surgically resected primary lung cancer cases (1003 cases) during the 15 year period of the study. The mean age of the patients was 59 years old, with 25 male cases. There were 23 smokers, smoking an average of 33 pack years. A cough was the most frequent symptom. There were 15 cases located in the peripheral part of the lung and 26 consisted of a lobulated mass. From a chest CT scan, 26 cases had necrotic portions, which appeared to be low density. The postoperative stages were IA, IB, IIB, IIIA and IV in 1 (3.6%), 11 (39.3%) 8 (28.5%), 7 (25%), 1 case (3.6%), respectively. The concordance rate of the pre- and postoperative stage was 43%. The median survival time and 5 year-survival rate were 54.5 months and 45%, respectively.

CONCLUSION

Our results suggested that a LCC in the lung was predominant in males, and equally located at the center and periphery of the lung in the surgically resected cases. To define the treatment outcome and risk factors of a LCC of the lung, further multicenter studies are needed.

Large cell carcinoma of the lung: results of resection for a cure

OBJECTIVE

The effectiveness of surgical resection of large cell undifferentiated carcinoma of the lung remains poorly defined because of the histology's relatively low frequency, the tendency for presentation with high-stage disease, and the failure in most published series to separate large cell carcinomas from the other variants of non-small cell lung carcinoma. To define the effectiveness of surgical treatment of large cell carcinoma, we reviewed the Mayo Clinic experience over a 5-year period.

METHODS

We have retrospectively reviewed the Mayo Clinic experience with 61 patients with large cell carcinoma and 17 patients with adenocarcinoma with focal mucin production who came to surgical resection during the 5-year period of January 1, 1982, through December 31, 1986.

RESULTS

One-hundred percent 5-year follow-up was obtained. For the 61 patients with large cell carcinoma, the overall 5-year survival was 37%. Five-year survival for those with stage I tumors was 58% (n = 31), stage II 33% (n = 6), stage IIIA 15% (n = 20), stage IIIB 0% (n = 2), and stage IV 0% (n = 2). No significant differences in survival were detected between the 61 patients with large cell carcinoma and the 17 patients with solid adenocarcinoma with mucin production.

CONCLUSIONS

Our results suggest that there is a subset of patients with large cell carcinoma of the lung who can undergo resection with a reasonable expectation of long-term survival and that this survival is, stage for stage, comparable to or only slightly less than that achieved with other non-small cell lung carcinomas.

Gastrin-releasing peptide gene expression in small cell and large cell undifferentiated lung carcinomas

Gastrin-releasing peptide (GRP; mammalian bombesin) is present in the neuroendocrine cells of human fetal lung and in small cell lung carcinomas (SCLCs), where it may act as a growth factor. Considering the potential importance of GRP as a tumor marker, we have conducted a retrospective immunohistochemical analysis of 176 lung tumors for markers of GRP gene expression, as well as several other markers of neuroendocrine cell differentiation: chromogranin A, neuron-specific enolase, and calcitonin. The majority of carcinoids contained mature GRP, in contrast to only a minority of SCLCs and large cell lung carcinomas (LCLCs). However, a majority of SCLCs and LCLCs contained proGRP immunoreactivity. In situ hybridization did not add any information beyond what was obtained using proGRP antisera. In spite of sharing these neuroendocrine cell markers, SCLCs are associated with a graver prognosis than LCLCs. No prognostic significance was associated with immunostaining for GRP or several other markers of neuroendocrine cell differentiation.

Large cell carcinoma of the lung: a highly aggressive tumor with dismal prognosis

A retrospective review was made of 96 consecutive patients with large cell carcinoma of the lung admitted to Emory University Hospital over 10 years. Only 10 patients were seen with stage I lesions favorable for resection. The remainder were treated primarily with irradiation or chemotherapy. Mean survival for clinical stage I patients was 15.9 months; stage IIIA patients, 7.9 months; stage IIIB patients, 7.1 months; and stage IV patients, 5.8 months. Only 1 patient survived for 5 years. This distinct and highly aggressive form of lung cancer most commonly is seen at an advanced stage and is associated with an unusually dismal prognosis regardless of the method of treatment employed.