Clinicopathological and Prognostic Features of 67 Cases With Pulmonary Sarcomatoid Carcinoma: An 18-Year Single Center Experience

Abstract

Introduction: The incidence of pulmonary sarcomatoid carcinoma(PSC) is around 0.5% among the subgroups of nonsmall cell lungcancer (NSCLC). PSC has 5 histological subtypes defined by theWHO: pleomorfic carcinoma, spindle cell carcinoma, giant cellcarcinoma, carcinosarcoma and pulmonary blastoma. In differentseries, the age at diagnosis varies between 55-70 years, and it ismore common in males and smokers. These tumors’prognosis ispoorer, even at an early stage. Nevertheless, promising alternativetreatments are on the agenda, with met-amplification and highlevels of PD-L1 seen in of these tumors in recent studies.Regarding current information, we evaluated the clinicopatholog-ical and prognostic data of patients in our center. Methods: 67patients have been identified in the last 18 years.. Gender, age, andsmoking information were recorded. Staging according to 8. editionof TNM was applied from the pre-treatment images. The correlationbetween the information of surgery, chemotherapy and radio-therapy administered to patients and survival was analyzed.Immunohistochemical (IHC) staining characteristics and patholog-ical findings were taken into account. Overall survival (OS) wasprimarily targeted in the survival analysis.Multivariate analysis wasused to analyze the independent factors on OS. Results: The de-mographic, clinicopathological and survival data are listed in table1. In accordance with the literature, the disease was more commonin men and smokers but demographic factors didn’t affect OS. Themedian OS was found to be statistically poorer in the presence ofadvanced stage, T4 tumor and lymph node positivity. Median OSwas significantly higher in patients who had surgery than those whodidn’t. Those who received adjuvant-neoadjuvant treatment had thebest survival among the treatment modalities. Tumor subtypesweren’t correlated with OS. However, in the subgroup with positiveepithelial marker the median OS significantly better than negatives.Surgical treatment and stage 4 disease were determined to be in-dependent variables in the multivariate analysis (HR: 0,27 and 3,94respectively).Conclusion: Because PSC is rare and heterogeneous, it can bechallenging and confusing for the clinician. In our retrospectivedata, early multimodal treatments, especially surgery, cancontribute to survival. Because our study is retrospective andincluded a small sample size, it has limitations, which makes itdifficult to evaluate our results. New classifications for the originof the disease will facilitate treatment and follow-up, and newtreatment alternatives will contribute to survival. Larger studiesare needed to achieve these goals. Keywords: sarcomatoid, metamplification, PD-L1