Analysis Of Clinical Features And Prognostic Factors Of Pulmonary Sarcomatoid Carcinoma

Objective: This study is to analyze the clinicopathological features,imaging findings,treatment methods and factors affecting the prognosis of patients with pulmonary sarcomatoid carcinoma,and provide data reference for the diagnosis and treatment of this particular pathological type of non-small cell lung cancer.Methods: The clinical data of 52 patients with pulmonary sarcomatoid carcinoma diagnosed and treated by the Cancer Hospital of China Medical University during the period from January to February 2018 were collected.The characteristics of clinical data were analyzed,and the statistical analysis between the research factors and the prognosis of the patients was performed.Results: In this study,52 cases of pulmonary sarcomatoid cancer accounted for 1.20% of the cases of lung cancer diagnosed and treated in our hospital at the same time.The patients were mainly elderly(61.5%),male(80.8%),and smoking(73.1%);cough and cough Blood is the most common clinical symptom.At the time of diagnosis,71.2% of patients had lymph node metastasis,and 34.6% had distant metastasis;adrenal gland,bone,and liver were common metastatic sites.The tumor diameter was 2.4~12.0cm,the median value was 4.6cm,the shape was irregular,the density was uneven,and the cavity lesions were visible in some lesions.CT enhanced scan showed that most(77.1%)lesions were unevenly enhanced,and some patients(25.7%)The chest blood vessels are invaded.Eight patients underwent PET-CT.The SUV of 18F-FDG in the lung mass ranged from 7.8 to 19.4,and the average SUV was 13.53±3.29,which was significantly higher than that of the normal T non-small cell lung cancer of the same T stage(P<0.001).There were 3 gene mutations,1 EGFR mutation,1 ALK mutation,and 1 MET mutation.27 cases were treated with surgery,13 cases were operated alone,14 cases were adjuvant chemotherapy;25 cases were treated without surgery,15 cases were palliative radiotherapy and chemotherapy;2 cases were targeted therapy;8 cases were not treated.Forty patients died of tumor recurrence and metastasis,10 survived and 2 were lost to follow-up.The median survival of the patients was 6.5 months,and the 1-,2-,and 3-year cumulative survival rates were 44.7%,28.2%,and 13.5%,respectively.Univariateanalysis showed: regional lymph node metastasis(P=0.001),presence or absence of distant organ metastasis(P<0.001),tumor stage(P<0.001),surgery(P<0.001),and postoperative adjuvant chemotherapy(P=0.039)was a prognostic factor;multivariate analysis showed that there was no distant organ metastasis(P=0.005)and tumor stage(P=0.008)were independent prognostic factors.Conclusion: Patients with pulmonary sarcomatoid carcinoma are rare in clinical practice.They have no special clinical symptoms.Histopathology and immunohistochemistry are the methods of diagnosis.At the same time,chest enhancement CT and PET-CT have certain specificity to assist diagnosis.Such lung cancer is invasive,easy to metastasize,and the prognosis of patients is poor.The independent factors affecting the prognosis are whether there is distant metastasis and tumor staging.Early surgical resection and adjuvant chemotherapy are the main treatment methods,and late palliative radiotherapy and chemotherapy are not effective.Molecular targeted drugs and PD-1/PD-L1 immunotherapy may help to improve the prognosis.