Clinical and molecular characteristics of pulmonary sarcomatoid carcinoma

Abstract

Background/AimsPulmonary sarcomatoid carcinoma (PSC) is a poorly differentiated non-small cell lung cancer (NSCLC) that contains components of spindle or giant cells. Owing to its low prevalence, there are insufficient data regarding its clinical features, therapeutic strategies and prognosis.MethodsThe medical records of 26 patients diagnosed with PSC from January 2009 to June 2015 were reviewed and analyzed for clinicopathological characteristics, treatment modality, and outcomes.ResultsThe median age was 69.5 years. Twenty-three patients (88%) were male. Twenty-four patients (92%) were smokers. The median time from symptom onset to diagnosis was one month. Eighteen patients (69%) were diagnosed at an advanced stage. Pleomorphic carcinoma was the most common subtype, and epidermal growth factor receptor (EGFR) mutation was positive in two of 11 patients. Among 13 patients tested for programmed death ligand 1 (PD-L1) immunohistochemistry assay, eight showed high expression of PD-L1. The median overall survival (OS) of all patients was 9.5 months. In total, 12 patients were treated with chemotherapy: nine with platinum-based doublet therapy, two with tyrosine kinase inhibitor, and one with docetaxel. Seven patients showed partial response or stable disease. The median OS and progression-free survival of patients who received chemotherapy were 8.7 and 2.8 months, respectively.ConclusionsPSC was more common in males, smokers, and the elderly, with worse prognosis than ordinary NSCLC; chemotherapy response was favorable, and EGFR mutation status and PD-L1 expression may offer more therapeutic options.

Clinical, pathological and treatment factors associated with the survival of patients with pulmonary sarcomatoid carcinoma

“…Variable HR 95% CI P-value HR 95% CI P- cell carcinoma, pleomorphic carcinoma and carcinosarcoma. Previous reports demonstrated that pleomorphic carcinoma was a common histological subtype (1,3,21,22). The WHO 2015 lung cancer classification (14) reported that the least common subtype of PSC is pulmonary blastoma (23), which is consistent with the findings of the present study.…”

“…Pulmonary sarcomatoid carcinoma (PSC) is a rare type of non-small cell lung cancer (NSCLC) composed of poorly differentiated cells and sarcoma or sarcomatoid components (spindle and/or giant cells) (1). PSC accounts for 0.3-1.0% of all lung cancer cases (2,3).…”

<p>Approaches to Tumor Classification in Pulmonary Sarcomatoid Carcinoma</p>

“…28-8 and SP263 primary antibodies. Sim et al 126 showed high levels of PD-L1 in 8 out of 13 PSC (61.5%) and Yvorel et al 127 analogously reported high expression of PD-L1 (clone E1L3N, Cell Signaling Technology) in 75% of 36 PSC. In the series of Kim et al 129 PD-L1 and PD-L2 were highly expressed in PSC (90.2%; 37/41 and 87.8%; 36/41), respectively.…”

“…In PSCs, several reports have investigated the expression of PD1 and/or PD-L1 to envisage a possible use of these therapies in this setting. 101,[123][124][125][126][127][128][129][130][131][132][133] Although widely employed and approved from different national drug agencies, 123 PD-L1 expression is an imperfect predictive biomarker for immunotherapy in lung cancer. PSC tends to show high levels of immunohistochemical expression with PD-L1, even if it is quite difficult to compare the data so far reported in literature in this histology.…”

Resected case of stage IV pleomorphic carcinoma of the lung with long-term survival

“…Pleomorphic carcinoma consists of poorly differentiated adenocarcinoma, squamous cell carcinoma, or large cell carcinoma containing at least 10% spindle and/or giant cells or a carcinoma comprised only of spindle and giant cells [11]. For tumors containing a wide range of cellular components, pleomorphic carcinoma is the most common subtype of sarcomatoid carcinomas [12].…”