Results of surgical resection of locally advanced pulmonary neuroendocrine tumors

Background: Pulmonary neuroendocrine tumors (pNETs) include well-differentiated and poorly differentiated histology for which cell type has proved to be a determinant of survival in many studies. In patients diagnosed with Bronchial Carcinoid (BC) and Large Cell Neuroendocrine Carcinoma (LCNEC), surgery is the treatment of choice even in the case of locally advanced disease with lymph node involvement. Methods: We retrospectively analyzed patients undergoing anatomical lung resection for BC or LCNEC with lymph node involvement (N1/N2) at the final pathological examination (pN+). Characteristics of patients and differences in overall survival (OS) and Disease Free Survival (DFS) are presented according to tumor type. Overall survival (OS) of distinct histological groups was compared with survival in our institutional experience in stage I-patients, without nodal involvement (pN0). Results: 325 patients underwent surgical resection forneuroendocrine tumors ; 89 patients had nodal involvement. 5-year survival was 89% in pN+ BCs both for typical (TC) and atypical carcinoid (AC) but worse in pN+ LCNEC (47%). Cell type did not influence the prognosis in N0-disease, and no differences in survival were evident between N0 and N+ in BC group. In the group of LCNEC, 5-year OS was much worse for pN+ LCNEC (47%) compared with pN0 LCNEC (91%). Conclusions: BCs have the best prognosis, and surgery remains the treatment of choice both for early and locally advanced disease. On the contrary, aggressive forms (LCNEC) with lymph nodal metastasis have a poor prognosis, and they need to be treated with an aggressive multidisciplinary approach.