Background:
Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of lung cancer. Both small-cell lung cancer (SCLC) and LELC often manifest as a centrally located tumor with lymphadenopathy. This retrospective study investigated and compared the initial computed tomography (CT) features and subsequent survival outcomes of LELC and SCLC.
Methods:
A total of 50 patients with a confirmed diagnosis of LELC were enrolled and matched at a ratio of 1:1 with patients with SCLC according to the tumor stage. Utilizing a consensus approach, two radiologists reviewed pretreatment CT images. Survival outcomes were analyzed.
Results:
Well-defined tumors were significantly more common in the LELC group (LELC: 42% vs SCLC: 24%,
p
= 0.005). Based on the comparisons of the primary tumor with the muscles, LELC tumors exhibited a significantly higher percentage of attenuation on contrast-enhanced CT scans (21.6% ± 29% vs −14.2% ± 37%,
p
< 0.001). The prevalence of vascular or bronchial encasement (18% vs 40%,
p
= 0.028), background emphysematous changes (10% vs 60%,
p
< 0.001), and tumors located in upper lobes (18% vs 64%,
p
< 0.001) was significantly lower in the LELC group. Female gender (70% vs 12%,
p
< 0.001), younger age (57.6 ± 12.0 years vs 68.0 ± 11.0 years,
p
< 0.001), and without a history of smoking (16% vs 88%,
p
< 0.001) were factors more commonly found in the LELC group. The patients with LELC had a better prognosis with significantly longer median survival than did the patients with SCLC (23.4 months vs 17.3 months,
p
= 0.01).
Conclusion:
Because SCLC demonstrated a more aggressive disease progression, differentiating LELC from SCLC is crucial. In Epstein–Barr virus-endemic areas, the diagnosis of LELC should be considered when approaching a patient with the above-mentioned CT and clinical features.