Background and Aim:

Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare neoplasm, and its clinical features and management are still limited. We evaluated the clinicopathological factors, including CDX2 immunohistochemical expression, to predict survival in patients with LCNEC.

Patients and Methods:

In all, 50 patients with LCNEC who underwent surgery at 4 institutes between 2001 and 2017 were included. Clinicopathological characteristics were evaluated for prognostic factors and statistically analyzed by Kaplan-Meier curve with a log-rank test or Cox regression models. We used immunohistochemical (IHC) analysis to determine the expressions of CDX2 and compared them with clinicopathological factors and survival.

Results:

Sixteen of the 50 cases (32%) were CDX2 positive. No correlation was found between the CDX2 expression by IHC and clinicopathological factors. Multivariate analysis identified adjuvant chemotherapy (hazard ratio [HR] =2.86, 95% confidence interval [CI] = 1.04-8.16, P = .04) and vascular invasion (HR = 4.35, 95% CI = 1.21-15.63, P = .03) as being associated with a significantly worse rate of recurrence-free survival.

Conclusion:

CDX2 was expressed in 1/3 of LCNEC but not associated with prognostic factor. Adjuvant chemotherapy and vascular invasion were associated with a negative prognostic factor of LCNEC.

中文翻译：

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可切除肺大细胞神经内分泌癌CDX2表达及预后因素

背景和目的：

肺大细胞神经内分泌癌（LCNEC）是一种罕见的肿瘤，其临床特征和治疗仍然有限。我们评估了临床病理因素，包括 CDX2 免疫组织化学表达，以预测 LCNEC 患者的生存率。

患者和方法：

总共包括 2001 年至 2017 年间在 4 个机构接受手术的 50 名 LCNEC 患者。评估临床病理学特征的预后因素，并通过 Kaplan-Meier 曲线和对数秩检验或 Cox 回归模型进行统计分析。我们使用免疫组织化学 (IHC) 分析来确定 CDX2 的表达，并将它们与临床病理因素和存活率进行比较。

结果：

50 例中有 16 例（32%）为 CDX2 阳性。IHC 检测的 CDX2 表达与临床病理因素之间未发现相关性。多变量分析确定了辅助化疗（风险比 [HR] = 2.86, 95% 置信区间 [CI] = 1.04-8.16, P  = .04）和血管侵犯（HR = 4.35, 95% CI = 1.21-15.63, P  = . 03）与显着更差的无复发生存率相关。

结论：

CDX2 在 LCNEC 的 1/3 中表达，但与预后因素无关。辅助化疗和血管侵犯与 LCNEC 的一个负面预后因素相关。