摘要目的：根据2015年WHO肺、胸膜、胸腺、心脏肿瘤分类提出的大细胞肺癌（ LCC）分型标准，分析93例LCC各亚型的临床病理学特点。方法回顾性分析1634例经手术切除的非小细胞肺癌中93例LCC的临床病理特点和免疫组织化学特点，并结合生存情况进行分析。结果93例LCC中实体型腺癌50例（53．8％），非角化型鳞状细胞癌21例（22．6％），腺鳞癌表型3例（3．2％），免疫组织化学表型不明确者8例（8．6％），裸免疫表型11例（11．8％），LCC各免疫表型间的临床特征差异并不显著。入选病例1、3、5年的总体生存率为51．0％、5．4％和1．1％；中位生存期为（15．2±1．2）个月（95％CI 12．88～17．55），其中裸免疫表型者预后最差，1年生存率仅为18％，与实体型腺癌或非角化型鳞癌相比差异有统计学意义（ P＜0．05）。结论免疫组织化学分型取代了原有的形态学分型成为LCC新分型的基础，其中裸免疫表型的预后最差，可能代表着一类独特的真正意义上的未分化癌。

abstractsObjective To analyze the clinicopathologic characteristics of large-cell lung carcinoma ( LCC) subtypes according to the 2015 WHO classification.Methods A total of 93 cases of LCC were identified among 1 634 cases of morphologically undifferentiated non-small cell lung carcinoma. Clinicopathologic and immunohistochemical characteristics were retrospectively reviewed.Results Among 93 cases of LCC, 50 cases were solid adenocarcinoma (53.8%), 21 cases were non-keratinzing squamous cell carcinoma ( 22.6%) , 3 cases were adenosquamous carcinoma ( 3.2%) , 8 cases were large cell carcinoma with unclear immunohistochemical features (8.6%) , and 11 cases were large cell carcinoma with null immunohistochemical features ( 11.8%) .No significant differences in clinical features were found among various immunophenotypes.The overall survival of 1, 3 and 5 years of all cases was 51.0%, 5.4%and 1.1%, respectively and the mean survival was ( 15.2 ±1.2 ) months.Notably the null type had the lowest survival rate of 18% in one year, significantly worse than those of solid adenocarcinoma and non-keratinzing squamous cell carcinoma. Conclusions The 2015 WHO classification based on immunohistochemical phenotype replaces the morphological approach in separating poorly differentiated non-small cell lung carcinoma from the former large cell lung carcinoma.The null immunohistochemical subtype may represent a distinct subtype of undifferentiated carcinoma with the worst prognosis.