Prognostic impact of nestin expression in resected large cell neuroendocrine carcinoma of the lung

Abstract

Background: Large cell neuroendocrine carcinoma (LCNEC) of the lung is categorized as a high-grade neuroendocrine carcinoma with an aggressive clinical behavior. Nestin is a class VI intermediate filament protein expressed in stem/progenitor cells during central nervous system development. Recently, we reported that nestin expression is a prognostic indicator of a poorer survival probability in patients with resected NSCLC. In the present study, we aimed to determine its prognostic significance concerning survival in patients with resected LCNEC.

Materials and methods: Nestin expression in tumor cells was immunohistochemically studied in 30 patients with resected LCNEC, and its associations with clinicopathologic parameters including the Ki-67 labeling index (LI) and TTF-1 expression were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of nestin expression on survival.

Results: Nestin expression was observed in 8 of the 30 (26.7%) LCNECs. Clinicopathologically, although no significant association between nestin expression and age, gender, smoking habits, p-TNM stage, tumor size, nodal status, or TTF-1 expression was observed, nestin expression was significantly associated with a high Ki-67 LI (P=0.012). On survival analysis, nestin expression was significantly associated with a poorer prognosis in patients with LCNEC (P=0.016). The Cox proportional regression model confirmed that the crude hazard ratio (95%CI) of nestin expression was 3.40 (1.18-9.77).

Conclusions: The present study suggests that nestin expression seems to be a prognostic indicator of a poorer survival probability in patients with resected LCNEC, although its prognostic significance still requires confirmation with larger patient populations.