Primary pulmonary lymphoepithelioma-like carcinoma in Singapore

Abstract

BACKGROUND:Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare subtype of nonsmall cell lung cancer (NSCLC) predominantly reported in East Asia. We aimed to evaluate clinical characteristics, diagnosis, treatment, and prognosis of PPLELC in Singapore.METHODS:Retrospective review of all patients diagnosed with PPLELC at our center between 2000 and 2014.RESULTS:All 28 patients were Chinese, 67.9% were female, and the median age was 58 years (range37–76 years). Majority (89.3%) were never smokers and 53.6% asymptomatic at diagnosis. About 28.6% presented with Stage I/II disease, 25% had Stage III disease, and 46.4% had Stage IV disease. All patients with Stage I/II disease underwent lobectomy without adjuvant treatment. Four out of 7 patients with Stage III disease underwent surgery with or without adjuvant therapy while the rest received chemoradiation. Twelve out of 13 patients with Stage IV disease received chemotherapy with or without radiotherapy. At the end of 2016, survival data were available for all 28 patients. Two-year survival rates for Stage I/II, Stage III, and Stage IV disease were 100%, 85.7%, and 61.5%, respectively, while survival was 100%, 85.7%, and 9.6%, respectively, at five years.CONCLUSION:The majority (46.4%) of patients presented with metastatic disease. For those with Stage I-III disease, 5-year survival for PPLELC was better than other NSCLC subtypes. Multimodality treatment including surgery could be considered in locally advanced disease. In Stage IV disease, it tended to approximate that of NSCLC.

Computed tomography-based differentiation of primary pulmonary lymphoepithelioma-like carcinoma and small-cell lung cancer

“…In our study, the patients with LELC and SCLC exhibited some characteristic clinical features, which are consistent with the findings of previous studies. First, SCLC was significantly more prevalent among male patients, 11 , 15 , 22 whereas LELC was significantly more prevalent among nonsmoking and female patients. 4 , 12 , 29 Second, compared with patients with SCLC, patients with LELC were frequently diagnosed at younger ages.…”

“… 3 Larger series of LELC have mostly been reported in East Asia, particularly in southern China, 1 , 4 – 7 Taiwan, 8 , 9 Hong Kong, 10 and Singapore. 11 The common manifestations of LELC on computed tomography (CT) scans include a tumor with homogeneous enhancement and the presence of lymphadenopathy, and late-staged lesions of LELC are often centrally situated in the lungs while early-stage tumors are often located peripherally. 2 , 6 , 10 , 12 , 13 The prognosis of patients with pulmonary LELC is more favorable than that of patients with non-LELC NSCLC.…”

Surgical treatment of Epstein-Barr virus–associated lymphoepithelioma-like carcinoma occurring in both the posterior mediastinum and liver

“…The overall survival rate for patients with advanced LELC is low. Tay et al [ 28 ] reported 5-year survival rates for advanced stage patients with PLELC in Singapore as less than 10%. Combination therapy is the best option to achieve the best possible outcome.…”

Clinical silence of pulmonary lymphoepithelioma-like carcinoma with subcutaneous metastasis: a case report

“…It is known that patients with PLELC have a better prognosis than those having other types of non-small cell lung cancer (NSCLC) [3]. However, the prognosis of stage IV-PLELC is not better than that of NSCLC [9, 10]. As to the treatment for PLELC, complete resection is the primary approach to obtain a cure, but treatment for advanced PLELC is controversial, owing to its being a rare entity [3].…”