Prognostic Factors in Patients Undergoing Pulmonary Resection for Sarcomatoid Carcinomas of the Lung

Abstract

Background Pulmonary sarcomatoid carcinomas are very rare lung neoplasms, and no consensus exists regarding their optimal treatment. The prognosis of sarcomatoid carcinomas has been reported to be unfavorable compared with non-small-cell lung cancers; however, prognostic factors in patients undergoing surgery for sarcomatoid carcinomas remain unclear. Aims To analyze clinicopathologic prognostic factors and survival outcomes in patients who underwent surgery for pulmonary sarcomatoid carcinoma. Study Design Retrospective cross-sectional study. Methods We designed a retrospective cross-sectional study in patients who underwent surgery for pulmonary sarcomatoid carcinomas and statistically analyzed the prognostic factors regarding clinicopathologic features with respect to survival outcomes. Results We had a total of 44 patients with sarcomatoid carcinoma who had pulmonary resection. Sex distribution was 34 (77%) males and 10 (22.7%) females, which was determined by declaration. The mean age of patients was 57.3 ± 16 years with a median of 60 years. The 5-year progression-free survival and overall survival rates were 59% and 58%, respectively. The 5-year survival rates were significantly different for tumors > 5 cm ( P = 0.044), tumorstatus (T) ( P =0.016), lymph node status (N) ( P =0.005), and pathologic tumor-node-metastasis (TNM) stage ( P = 0.0001 ). However, histologic subtype ( P = 0.628) and adjuvant treatment ( P = 0.804) did not have any significant effect on survival. Similarly, the significant prognostic factors in univariate analysis were tumor size ( P = 0.085), T status ( P = 0.005), N status ( P = 0.028), and pathologic TNM stage ( P = 0.0001). Multivariate analysis showed only T status ( P = 0.058), N status ( P = 0.018), and pathologic TNM stage ( P = 0.019) as independent prognostic factors, with statistical power of 87%, 43.1% and 21.2%. Conclusion Surgery appears to be an optimal treatment with favorable outcomes for patients with pulmonary sarcomatoid carcinoma. Patients with small tumors at earlier stages are very likely to benefit from surgery, regardless of histologic subtype.

Clinical characteristics and prognostic factors of pulmonary sarcomatoid carcinoma

“…Surgery is the main therapeutic method for PSC, especially for early-stage diseases; most patients in our study underwent surgery ( 8 , 20 , 21 ). PSC is rarely diagnosed by biopsy; thus, only a few patients receive neoadjuvant therapy.…”

Sarcomatoid lung cancer in a 56-year-old woman

“…Sarcomatoid lung carcinoma (SLC) is a poorly differentiated non-small cell lung cancer (NSCLC), representing up to 0.4% of pulmonary malignancies and 0.52% of the NSCLCs, and a biphasic histopathologic feature showing carcinomatous and sarcomatous data. [1][2][3][4][5][6][7][8] Over 50% of the SLCs have the pleomorphic pattern, followed by spindle cell, giant-cell, carcinosarcoma, and blastoma subtypes. [1][2][3] SLC more frequently affects elderly males, tobacco smokers, and can develop both as an endobronchial exophytic growth or a rounded voluminous mass that may involve the thoracic wall similarly to the mesotheliomas.…”

“…[1][2][3][4][5][6][7][8] Over 50% of the SLCs have the pleomorphic pattern, followed by spindle cell, giant-cell, carcinosarcoma, and blastoma subtypes. [1][2][3] SLC more frequently affects elderly males, tobacco smokers, and can develop both as an endobronchial exophytic growth or a rounded voluminous mass that may involve the thoracic wall similarly to the mesotheliomas. [1][2][3][4]6 SLC and sarcomatoid mesothelioma may have similarities causing diagnostic challenges, and the distinction between them is more relevant due to the option for targeted therapy.…”

“…[1][2][3] SLC more frequently affects elderly males, tobacco smokers, and can develop both as an endobronchial exophytic growth or a rounded voluminous mass that may involve the thoracic wall similarly to the mesotheliomas. [1][2][3][4]6 SLC and sarcomatoid mesothelioma may have similarities causing diagnostic challenges, and the distinction between them is more relevant due to the option for targeted therapy. 4 SLC may be peripheral or central, and it is usually located in the upper lobes; peripheral tumors more often give metastasis, and the diameter and stage are prognostic factors.…”

“…4 SLC may be peripheral or central, and it is usually located in the upper lobes; peripheral tumors more often give metastasis, and the diameter and stage are prognostic factors. [2][3][4]6 The median survival of patients with SLC is 10 months and 15% is the 5-year survival due to late diagnosis, the highly aggressive behavior, and the resistance to chemotherapy; however, resection and chemotherapy or targeted immunotherapy can get better results. [1][2][3][4][5][6][7][8][9] Here, we report a patient with SLC who presented to our hospital with a history of non-productive cough and a lesion in the left upper lobe in computed tomography (CT).…”