Role of surgery in high-grade neuroendocrine tumors of the lung

Background: This study aims to evaluate the surgical results for high-grade neuroendocrine carcinomas and to identify factors that influence prognosis. Methods: Between January 2009 and December 2017, a total of 71 patients (58 males, 13 females; mean age: 62??9.6 years; range, 38 to 78 years) with a high-grade neuroendocrine carcinoma of the lung were retrospectively analyzed. Overall survival and five-year overall survival rates were evaluated. Results: The mean overall survival was 60.7??6.9 months with a five-year survival rate of 44.3%. The mean overall survival and five-year overall survival rates according to disease stage were as follows: Stage 1, 67??10.8 months (46%); Stage 2, 61.4??10.8 months (45%); and Stage 3, 33.2??8.6 months (32%) (p=0.02). The mean overall survival and five-year overall survival rate according to histological types were as follows: in large cell neuroendocrine carcinoma, 59.4??9.2 months (45%); in small cell neuroendocrine carcinoma, 68.6??12.2 months (43%); and in combined-type neuroendocrine carcinoma, 40.9??10.1 months (35%) (p=0.34). Conclusion: Thoracic surgeons should be very selective in performing pulmonary resection in patients with Stage 3 high-grade neuroendocrine carcinomas and combined cell subtype tumors.