Predictive factors of postoperative survival among patients with pulmonary neuroendocrine tumor

Abstract

Background: Pulmonary neuroendocrine tumor (NET) occurs with 20% of all lung cancers, and there are a limited number of literatures about the molecular aberrations, treatment and prognosis; especially in resected cases, as the operation indication for large cell neuroendocrine carcinoma (LCNEC) and small cell lung carcinoma (SCLC) is rare due to their aggressive behaviors. We investigated the relationship between postoperative survival and molecular expression patterns of pulmonary NET to establish a more effective treatment strategy.Methods: In the present study, the curative surgical resection of pulmonary NET was reviewed retrospectively. A total of 105 patients with pulmonary NET, who underwent complete resection between 1978 and 2016, were subjected to analysis with respect to histological characterization and clinical behaviors of pulmonary NET using immunohistochemistry (IHC) of neuroendocrine markers and programmed cell death-ligand 1 (PD-L1).Results: The pathological types included 67 SCLC, 18 LCNEC, 14 typical carcinoids (TCs) and 6 atypical carcinoids (ACs). The ACs had significantly worse prognosis than TCs. PD-L1 expression ratio in SCLC/LCNEC/TC/AC was 26.1%/50%/15.4%/20%, respectively. However, it was not significantly correlated with each prognosis. Therefore, the SCLC patients were analyzed, the overall 5-year survival of SCLC patients was found to be 47.3%. In the univariate analysis of the molecular expression of SCLC, neuroendocrine markers such as chromogranin-A (CGA) and synaptophysin (SYN) showed poor prognosis, albeit without significant differences. Conclusions:The neuroendocrine markers such as CGA and SYN might assist the prediction of prognosis and probably influence the decision for adjuvant chemotherapy or follow-up intervals after surgery in SCLC patients; however additional studies are essential.

Characterization of PD-L1 protein expression and CD8+ tumor-infiltrating lymphocyte density, and their associations with clinical outcome in small-cell lung cancer

“…A flowchart of publication selection was shown in Figure S3. The present study included 1,505 cases from 15 articles to investigate the prevalence of positive PD-L1 expression and its prognostic value in patients with SCLC (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). The main features of each study are summarized in Table 3 and Table S1.…”

An analysis of the immunological tumor microenvironment of primary tumors and regional lymph nodes in squamous cell lung cancer

“…The PD-L1 expression ratios in small cell carcinoma/large cell neuroendocrine carcinoma/typical carcinoid/atypical carcinoid were 26.1%/50%/15.4%/20%, respectively. However, this value was not significantly correlated with the prognoses of any of these patients (49). The influence of the PD-L1 expression by cancer cells on the prognosis varies among studies and remains controversial.…”

Multifocal neuroendocrine cell hyperplasia accompanied by tumorlet formation and pulmonary sclerosing pneumocytoma: A case report

“…However, people living in high-altitude regions and those with chronic pulmonary fibrosis such as bronchiectasis or interstitial pulmonary fibrosis may have NEC hyperplasia because of hypoxia and structural damage to the lungs. The hyperplasia is temporary and reversible; it does not typically progress into carcinoids[ 10 ].…”