TY - JOUR
T1 - Sarcomatoid Carcinoma of the Lung
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
AU - Yang, Ping
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/5
Y1 - 2018/5
N2 - Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of lung cancer (< 1% of lung cancer). The prognosis of PSC is significantly worse than that of typical non–small-cell lung cancer. Neoadjuvant or adjuvant chemotherapy, in addition to surgical resection, should be considered for early-stage PSC. PSC has shown a poor response to palliative conventional chemotherapy regimens. 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 - Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of lung cancer (< 1% of lung cancer). The prognosis of PSC is significantly worse than that of typical non–small-cell lung cancer. Neoadjuvant or adjuvant chemotherapy, in addition to surgical resection, should be considered for early-stage PSC. PSC has shown a poor response to palliative conventional chemotherapy regimens. 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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U2 - 10.1016/j.cllc.2017.12.008
DO - 10.1016/j.cllc.2017.12.008
M3 - Article
C2 - 29454534
AN - SCOPUS:85041931963
SN - 1525-7304
VL - 19
SP - e323-e333
JO - Clinical lung cancer
JF - Clinical lung cancer
IS - 3
ER -