Characteristics and Prognostic Analysis of 55 Patients With Pulmonary Sarcomatoid Carcinoma

Sun, Jiachun; Jiang, Zhiyi; Shan, Tanyou; Yang, Rong; Kong, Dejiu; Rui, Junshuai; Li, Xinyang; Kong, Guangwen; Chang, Bao-ping

doi:10.3389/fonc.2022.833486

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…In addition, they elucidated that the TNM stage, especially T staging and M staging, was associated with the prognosis of PSC. These data were consistent with previous studies ( 4 , 6 , 7 ).…”

supporting

confidence: 94%

Emerging new evidence for the treatment of pulmonary sarcomatoid carcinoma

Akaba¹,

Arimura²,

Tagaya³

2023

J Thorac Dis

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Lung cancer is a leading cause of cancer-related mortality, accounting for 1.8 million people worldwide in 2020 (1). Pulmonary sarcomatoid carcinoma (PSC) is a rare type of non-small cell lung cancer (NSCLC), characterized by poorly differentiated carcinoma with components of sarcoma or sarcoma-like differentiation. The most recent classification of PSC includes pleomorphic carcinoma, giant cell carcinoma, spindle cell carcinoma, pulmonary blastoma, and carcinosarcoma (2). Owing to the rapid advancement in cancer treatment and elucidation of disease mechanisms, the outcomes of lung cancer have drastically improved over the last decade. However, the prognosis of PSC is still poor compared to other forms of NSCLC (3,4). There is limited data regarding the standard treatment strategy, clinical characteristics, and prognostic factors due to the rarity of the disease. Therefore, this necessitates the accumulation of evidence for PSC.In a recent study, Zhao et al. reported the long-term follow-up data of 119 patients with PSC in a single cancer center in China (5). The authors described the data regarding the main features of patients with PSC and disease prognosis, including median survival and 1-, 3-, and 5-year overall survival based on patient characteristics. In addition, they elucidated that the TNM stage, especially T staging and M staging, was associated with the prognosis of PSC. These data were consistent with previous studies (4,6,7).Interestingly, more than 90% of patients underwent surgery in this study, and this proportion was substantially greater, despite the small number of Stage IV patients. Since surgical resection is the only known curative treatment for PSC, the relatively good overall survival in this study may be partly attributed to a proactive surgical treatment strategy (6). As emphasized by the authors, complete resection of a tumor should be targeted based on the patient's condition. However, mixed results exist on the effectiveness of chemotherapy in combination with surgery, and this study did not provide a definite conclusion regarding this point (4,6,8). Since a majority of the patients received adjuvant or neoadjuvant chemotherapy in current and previous studies, future studies focusing on the combination of chemotherapy and surgery are warranted (5,6).To date, there is no standard treatment regimen for management of advanced-stage PSC. A previous study on a French cohort showed that platinum-based chemotherapy modestly improved the outcomes of patients with PSC (9). However, patients with PSC tend to develop chemotherapy resistance at an early stage, thereby resulting in less efficacy. Therefore, similar to other NSCLCs, other treatment strategies, such as molecular-targeted drugs and immune checkpoint inhibitors, may play an important role in the treatment of advanced-stage PSC. The current study showed that 8/18 (44%) patients with PSC were positive for mutations in genes such as KRAS, EGFR, and ALK. In addition, some PSC patients harbored the MET mutation, and MET and KRAS mutations...

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supporting

confidence: 94%

Emerging new evidence for the treatment of pulmonary sarcomatoid carcinoma

Akaba¹,

Arimura²,

Tagaya³

2023

J Thorac Dis

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“…Pulmonary sarcomatoid carcinoma (PSC) is a rare subset of non-small-cell lung cancer (NSCLC), characterized by poorly differentiated tumors with a component of sarcoma or sarcomalike elements 1 and highly aggressive biological behaviors. [2][3][4][5] PSC has been reported to be associated with poor prognosis and low responsiveness to first-line chemotherapy, with an objective response rate (ORR) of 16.5% and overall survival (OS) of only 6.3 months. 6 Therefore, developing novel therapeutic strategies to improve the dismal prognosis of patients with this malignance is in high demand.…”

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitors plus chemotherapy in patients with locally advanced or metastatic pulmonary sarcomatoid carcinoma: a multicentric real-world study

Zhou

Guo

Zhou³

et al. 2022

Ther Adv Med Oncol

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Introduction: Immune checkpoint inhibitors (ICIs) have demonstrated promising efficacy as monotherapy in patients with pulmonary sarcomatoid carcinoma (PSC). We performed the current multi-institutional, real-world study to assess the efficacy of ICIs plus chemotherapy in patients with PSC. Methods: All consecutive patients with locally advanced or metastatic PSC from three centers treated with ICIs between January 2018 and July 2021 were enrolled. Programmed death ligand 1 (PD-L1) expression was stained and evaluated using immunohistochemical with 22C3. Single-cell RNA sequencing (scRNA-seq) was performed in two patients with PSC and two patients with adenocarcinoma to understand the cell-type-specific transcriptome landscape of cancer cells and tumor microenvironment (TME) of PSC. Results: A cohort of 42 PSC patients was identified. In the overall population, the objective response rate (ORR) was 73.8%, median progression-free survival (mPFS) was 10.3 months and median overall survival was not reached and 2-year survival rate was 51.2%. For 34 treatment-naïve patients who received first-line ICIs plus chemotherapy, the ORR was 70.6%, mPFS was 10.3 months and 2-year survival rate was 57.8%. In patients with PD-L1 tumor proportion score (TPS) < 1%, 1–49%, and ⩾50%, the ORR was 33.3%, 72.7%, and 85.7% and mPFS was 6.0, 6.7, and 10.3 months, respectively. Notably, two patients with transformed PSC from lung adenocarcinoma after epidermal growth factor receptor-tyrosine kinase inhibitor treatment also responded well to ICIs plus chemotherapy. scRNA-seq revealed immune-cell-inflamed TME, lower intratumoral heterogeneity, and activated immune response pathway in PSC. Conclusions: Our study demonstrated remarkable efficacy of ICIs plus chemotherapy as first-line therapy for patient with locally advanced or metastatic PSC.

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“…Additionally, the presence of mediastinal lymph node metastasis has been correlated with an increased risk of distant metastasis and reduced overall survival. These findings underscore the importance of early detection and accurate staging of lymph node involvement in the management of PSC (21,22). Zhao et al ( 23) demonstrated a higher prevalence of smoking history in patients with PSC and its close association with poor prognosis.…”

Section: Discussionmentioning

confidence: 82%

Computed Tomography-Based Radiomics Analysis of Different Machine Learning Approaches for Differentiating Pulmonary Sarcomatoid Carcinoma and Pulmonary Inflammatory Pseudotumor

Zhang,

Fu,

2024

I J Radiol

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Background: Differentiating between pulmonary sarcomatoid carcinoma (PSC) and pulmonary inflammatory pseudotumor (PIP) is challenging using current conventional diagnostic methods. This lack of distinction significantly impacts subsequent clinical treatment decisions. Objectives: This study was conducted to construct an effective method to distinguish between PSC and PIP based on commonly used computed tomography (CT) images. Patients and Methods: A total of 14 patients with PSC and 76 patients with PIP were retrospectively included in the study for CT imaging. Radiomics features were extracted from non-enhanced CT images, and canonical correlation analysis was performed to reduce redundancy. The final radiomics signature was then identified using the least absolute shrinkage and selection operator (LASSO). Logistic regression (LR), classification and regression trees (CART), support vector machine (SVM), k-nearest neighbors (KNN), and gradient boosting machine (GBM) were used to construct the radiomics models. The performance of these different radiomics models was evaluated using the receiver operating characteristic curve. Results: A total of 1186 radiomics features were extracted from non-enhanced CT images. After dimensionality reduction and selection, 7 valuable features were identified. The performance of 5 machine learning models was evaluated to differentiate between PSC and PIP, and the GBM-based radiomics model demonstrated the best performance. The GBM-based radiomics model achieved an accuracy of 0.922, area under the curve (AUC) of 0.98, F1 score of 0.967, and log loss of 0.161. Compared to conventional clinical-radiological diagnosis, the GBM-based radiomics model showed a significant association (odds ratio [OR] = 8.119; P = 0.006). Conclusion: The implementation of the GBM-based radiomics model has the potential to improve the ability to differentiate between PSC and PIP, thereby influencing the timeliness of subsequent surgical interventions and even the prognosis of patients.

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Characteristics and Prognostic Analysis of 55 Patients With Pulmonary Sarcomatoid Carcinoma

Cited by 5 publications

References 27 publications

Emerging new evidence for the treatment of pulmonary sarcomatoid carcinoma

Emerging new evidence for the treatment of pulmonary sarcomatoid carcinoma

Immune checkpoint inhibitors plus chemotherapy in patients with locally advanced or metastatic pulmonary sarcomatoid carcinoma: a multicentric real-world study

Computed Tomography-Based Radiomics Analysis of Different Machine Learning Approaches for Differentiating Pulmonary Sarcomatoid Carcinoma and Pulmonary Inflammatory Pseudotumor

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