Sarcomatoid Carcinoma of the Lung

The Mayo Clinic Experience in 127 Patients

Kunlatida Maneenil, Zhiqiang Xue, Ming Liu, Jennifer Boland, Fengying Wu, Shawn M. Stoddard, Julian R Molina, Ping Yang

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Pulmonary sarcomatoid carcinoma (PSC) is an unusual form of non-small-cell lung cancer (NSCLC). Because of its rarity and heterogeneity, the treatment and prognosis of PSC have not been clearly described. Methods and Materials: We retrospectively evaluated all patients with a diagnosis of PSC from 1997 to 2015 at the Mayo Clinic (Rochester, MN). The clinical characteristics, treatment details, and outcomes were collected. The survival rates of the PSC patients were compared with those for other subtypes of NSCLC. We used propensity score matching to minimize the bias resulting from to imbalanced comparison groups. Results: The study included 127 PSC patients. The median age at diagnosis was 68 years (range, 32-89 years), most of whom were men (61%) and smokers (82%). The clinical stage was I, II, III, and IV in 15.9%, 20.6%, 22.2%, and 41.3%, respectively. The median survival time was 9.9 months (95% confidence interval [CI], 7.6-12.6 months). The 1-, 2-, and 5-year survival rates were 42%, 23%, and 15%, respectively. Most patients received multimodality treatment. Of the 3 patients who received neoadjuvant chemotherapy, a partial response was demonstrated in 2. Twenty-five patients who underwent palliative chemotherapy were evaluated for tumor response: 52% experienced progression, 40% stable disease, 8.0% a partial response, and 0% a complete response. Multivariate analysis showed T stage, M stage, and treatment with surgery plus neoadjuvant chemotherapy or surgery plus adjuvant therapy were independent prognostic factors (P < .05). In matched analysis, multivariate models revealed worse overall survival for PSC compared with adenocarcinoma (hazard ratio, 2.38; 95% CI, 1.61-2.53) and squamous cell carcinoma (hazard ratio, 2.20; 95% CI, 1.44-2.34). Conclusion: We found the outcome of PSC to be significantly worse than that of adenocarcinoma and squamous cell carcinoma. Neoadjuvant or adjuvant chemotherapy, in addition to surgical resection, should be considered.

Original languageEnglish (US)
JournalClinical Lung Cancer
DOIs
StateAccepted/In press - Jan 1 2018

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Carcinoma
Lung
Confidence Intervals
Drug Therapy
Non-Small Cell Lung Carcinoma
Squamous Cell Carcinoma
Adenocarcinoma
Multivariate Analysis
Survival Rate
Propensity Score
Survival
Therapeutics
Adjuvant Chemotherapy
Neoplasms

Keywords

  • Chemotherapy
  • Lung cancer
  • Non-small-cell lung cancer
  • Prognosis
  • Pulmonary sarcomatoid carcinoma

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Sarcomatoid Carcinoma of the Lung : The Mayo Clinic Experience in 127 Patients. / Maneenil, Kunlatida; Xue, Zhiqiang; Liu, Ming; Boland, Jennifer; Wu, Fengying; Stoddard, Shawn M.; Molina, Julian R; Yang, Ping.

In: Clinical Lung Cancer, 01.01.2018.

Research output: Contribution to journalArticle

Maneenil, Kunlatida ; Xue, Zhiqiang ; Liu, Ming ; Boland, Jennifer ; Wu, Fengying ; Stoddard, Shawn M. ; Molina, Julian R ; Yang, Ping. / Sarcomatoid Carcinoma of the Lung : The Mayo Clinic Experience in 127 Patients. In: Clinical Lung Cancer. 2018.
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abstract = "Background: Pulmonary sarcomatoid carcinoma (PSC) is an unusual form of non-small-cell lung cancer (NSCLC). Because of its rarity and heterogeneity, the treatment and prognosis of PSC have not been clearly described. Methods and Materials: We retrospectively evaluated all patients with a diagnosis of PSC from 1997 to 2015 at the Mayo Clinic (Rochester, MN). The clinical characteristics, treatment details, and outcomes were collected. The survival rates of the PSC patients were compared with those for other subtypes of NSCLC. We used propensity score matching to minimize the bias resulting from to imbalanced comparison groups. Results: The study included 127 PSC patients. The median age at diagnosis was 68 years (range, 32-89 years), most of whom were men (61{\%}) and smokers (82{\%}). The clinical stage was I, II, III, and IV in 15.9{\%}, 20.6{\%}, 22.2{\%}, and 41.3{\%}, respectively. The median survival time was 9.9 months (95{\%} confidence interval [CI], 7.6-12.6 months). The 1-, 2-, and 5-year survival rates were 42{\%}, 23{\%}, and 15{\%}, respectively. Most patients received multimodality treatment. Of the 3 patients who received neoadjuvant chemotherapy, a partial response was demonstrated in 2. Twenty-five patients who underwent palliative chemotherapy were evaluated for tumor response: 52{\%} experienced progression, 40{\%} stable disease, 8.0{\%} a partial response, and 0{\%} a complete response. Multivariate analysis showed T stage, M stage, and treatment with surgery plus neoadjuvant chemotherapy or surgery plus adjuvant therapy were independent prognostic factors (P < .05). In matched analysis, multivariate models revealed worse overall survival for PSC compared with adenocarcinoma (hazard ratio, 2.38; 95{\%} CI, 1.61-2.53) and squamous cell carcinoma (hazard ratio, 2.20; 95{\%} CI, 1.44-2.34). Conclusion: We found the outcome of PSC to be significantly worse than that of adenocarcinoma and squamous cell carcinoma. Neoadjuvant or adjuvant chemotherapy, in addition to surgical resection, should be considered.",
keywords = "Chemotherapy, Lung cancer, Non-small-cell lung cancer, Prognosis, Pulmonary sarcomatoid carcinoma",
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T2 - The Mayo Clinic Experience in 127 Patients

AU - Maneenil, Kunlatida

AU - Xue, Zhiqiang

AU - Liu, Ming

AU - Boland, Jennifer

AU - Wu, Fengying

AU - Stoddard, Shawn M.

AU - Molina, Julian R

AU - Yang, Ping

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Pulmonary sarcomatoid carcinoma (PSC) is an unusual form of non-small-cell lung cancer (NSCLC). Because of its rarity and heterogeneity, the treatment and prognosis of PSC have not been clearly described. Methods and Materials: We retrospectively evaluated all patients with a diagnosis of PSC from 1997 to 2015 at the Mayo Clinic (Rochester, MN). The clinical characteristics, treatment details, and outcomes were collected. The survival rates of the PSC patients were compared with those for other subtypes of NSCLC. We used propensity score matching to minimize the bias resulting from to imbalanced comparison groups. Results: The study included 127 PSC patients. The median age at diagnosis was 68 years (range, 32-89 years), most of whom were men (61%) and smokers (82%). The clinical stage was I, II, III, and IV in 15.9%, 20.6%, 22.2%, and 41.3%, respectively. The median survival time was 9.9 months (95% confidence interval [CI], 7.6-12.6 months). The 1-, 2-, and 5-year survival rates were 42%, 23%, and 15%, respectively. Most patients received multimodality treatment. Of the 3 patients who received neoadjuvant chemotherapy, a partial response was demonstrated in 2. Twenty-five patients who underwent palliative chemotherapy were evaluated for tumor response: 52% experienced progression, 40% stable disease, 8.0% a partial response, and 0% a complete response. Multivariate analysis showed T stage, M stage, and treatment with surgery plus neoadjuvant chemotherapy or surgery plus adjuvant therapy were independent prognostic factors (P < .05). In matched analysis, multivariate models revealed worse overall survival for PSC compared with adenocarcinoma (hazard ratio, 2.38; 95% CI, 1.61-2.53) and squamous cell carcinoma (hazard ratio, 2.20; 95% CI, 1.44-2.34). Conclusion: We found the outcome of PSC to be significantly worse than that of adenocarcinoma and squamous cell carcinoma. Neoadjuvant or adjuvant chemotherapy, in addition to surgical resection, should be considered.

AB - Background: Pulmonary sarcomatoid carcinoma (PSC) is an unusual form of non-small-cell lung cancer (NSCLC). Because of its rarity and heterogeneity, the treatment and prognosis of PSC have not been clearly described. Methods and Materials: We retrospectively evaluated all patients with a diagnosis of PSC from 1997 to 2015 at the Mayo Clinic (Rochester, MN). The clinical characteristics, treatment details, and outcomes were collected. The survival rates of the PSC patients were compared with those for other subtypes of NSCLC. We used propensity score matching to minimize the bias resulting from to imbalanced comparison groups. Results: The study included 127 PSC patients. The median age at diagnosis was 68 years (range, 32-89 years), most of whom were men (61%) and smokers (82%). The clinical stage was I, II, III, and IV in 15.9%, 20.6%, 22.2%, and 41.3%, respectively. The median survival time was 9.9 months (95% confidence interval [CI], 7.6-12.6 months). The 1-, 2-, and 5-year survival rates were 42%, 23%, and 15%, respectively. Most patients received multimodality treatment. Of the 3 patients who received neoadjuvant chemotherapy, a partial response was demonstrated in 2. Twenty-five patients who underwent palliative chemotherapy were evaluated for tumor response: 52% experienced progression, 40% stable disease, 8.0% a partial response, and 0% a complete response. Multivariate analysis showed T stage, M stage, and treatment with surgery plus neoadjuvant chemotherapy or surgery plus adjuvant therapy were independent prognostic factors (P < .05). In matched analysis, multivariate models revealed worse overall survival for PSC compared with adenocarcinoma (hazard ratio, 2.38; 95% CI, 1.61-2.53) and squamous cell carcinoma (hazard ratio, 2.20; 95% CI, 1.44-2.34). Conclusion: We found the outcome of PSC to be significantly worse than that of adenocarcinoma and squamous cell carcinoma. Neoadjuvant or adjuvant chemotherapy, in addition to surgical resection, should be considered.

KW - Chemotherapy

KW - Lung cancer

KW - Non-small-cell lung cancer

KW - Prognosis

KW - Pulmonary sarcomatoid carcinoma

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