No alterations were found in DLL3 and ASCL1. All alterations of TP53, RB1, STK11 and KEAP1 were examined in 205 cases, of which 26 cases could be classified as type I LCNEC (TP53 and STK11/KEAP1 alterations), and 71 cases could be classified into type II LCNECs (TP53 and RB1 alterations). This evidence concerns the gene KEAP1 and large cell neuroendocrine carcinoma.