Clinical Features And Prognosis Of 79 Cases Of Pulmonary Sarcomatoid Carcinoma

Background and ObjectivePulmonary sarcomatoid carcinoma(PSC)is a group of poorly differentiated,rapidly developed and rare malignant tumor of the lung.It is characterized by the presence of sarcoma or sarcomatoid components(spindle cells and / or giant cells),accounting for about 0.1%~0.4% of all non-small cell lung cancer(NSCLC).According to the WHO classification of lung tumors in 2015,PSC was divided into five subtypes : pleomorphic carcinoma(PC),spindle cell carcinoma(SCC),carcinosarcoma(CS),giant cell carcinoma(GCC)and pulmonary blastoma(PB).Before 2004,there was no consistent diagnostic criteria to define PSC.The WHO now requires a surgical specimen for diagnosis,which can be supplemented with immunohistochemistry and electron microscopy.However,in the clinic work,a number of patients were found to be late in the disease,and the cost of obtaining accurate pathological diagnosis by surgical resection of tumors was high.The latest guidelines confirmed the diagnostic value of small biopsy samples.Due to the high malignancy,rapid progression,poor prognosis,and resistance to chemotherapy and radiotherapy than other types of lung cancer,surgical resection is still the firsttreatment option for PSC at present.However,most of the patients were found to be in the advanced stage and lost the opportunity of surgery,even if the early disease underwent radical resection,the postoperative recurrence rate is still high,so the treatment of PSC is still a challenge.In order to promote the understanding of pulmonary sarcomatoid carcinoma and improve the survival of those patients,we collected the clinical data of the patients diagnosed as PSC in recent years,and summarized their clinical characteristics,pathogenesis,pathological features,treatment methods and prognostic factors,thus providing a new data reference for clinicians.MethodsThe clinical data of 79 cases of pulmonary sarcomatoid carcinoma were analyzed retrospectively.The correlation between prognosis and gender,age,smoking history,primary tumor site,tumor size,location type,T staging,lymph node metastasis,distant metastasis,TNM staging,histological subtype,therapeutic method,surgery or not were analyzed by statistical software SPSS 19.0.Kaplan-Meier method was used for the estimation of 1-,2-,3-year survival rates and univariate analysis.The Log-rank method was used to test the significance of difference and Cox proportional hazard regression model was used to carry out multivariate analysis.ResultsPSC patients mainly presented with the symptoms of cough,chest tightness,fever,bloody sputum,hemoptysis,chest pain,which were similar to other types of lung cancer,such as adenocarcinoma,squamous cell carcinoma and small cell carcinoma.The overall 1-,2-,3-year survival rates were 25.3%,8.0%,4.8%,respectively.The median survival time was 8.0 months.Univariate analysis showed that age,tumor size,T stage,distant metastasis,TNM staging,treatment and surgery or not were prognostic factors.Multivariate Cox proportional hazard regression analysis indicated that age,tumor size and therapeutic method were independent prognostic factors for PSC.ConclusionPSC is a rare,aggressive,poorly-differentiated non-small cell lung cancer,with poor prognosis.Compared with other lung tumors,PSC lacks typical clini cal manifestations.The diagnosis mainly depends on pathology and immunohistochemistry.Age,tumor size and therapeutic method are independent prognostic factors.Surgical resection combined with postoperative chemo-radiotherapy is the preferred therapeutic method.