Division of Medical Oncology, Mayo Clinic, Rochester, MN; Oncology Unit, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
Department of Thoracic Surgery, People's Liberation Army General Hospital, Beijing, China; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN.
Clin Lung Cancer. 2018 May;19(3):e323-e333. doi: 10.1016/j.cllc.2017.12.008. Epub 2017 Dec 21.
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.
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.
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).
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.
肺肉瘤样癌（PSC）是一种不常见的非小细胞肺癌（NSCLC）形式。由于其罕见性和异质性，PSC 的治疗和预后尚未得到明确描述。
我们回顾性评估了 1997 年至 2015 年在梅奥诊所（明尼苏达州罗切斯特）诊断为 PSC 的所有患者。收集了临床特征、治疗细节和结果。将 PSC 患者的生存率与其他 NSCLC 亚型进行比较。我们使用倾向评分匹配来最小化因不平衡比较组而产生的偏差。
该研究包括 127 例 PSC 患者。诊断时的中位年龄为 68 岁（范围为 32-89 岁），大多数为男性（61%）和吸烟者（82%）。临床分期分别为 I、II、III 和 IV 期，分别占 15.9%、20.6%、22.2%和 41.3%。中位生存时间为 9.9 个月（95%置信区间[CI]为 7.6-12.6 个月）。1、2 和 5 年生存率分别为 42%、23%和 15%。大多数患者接受了多模式治疗。3 例接受新辅助化疗的患者中，2 例显示部分缓解。25 例接受姑息化疗的患者评估肿瘤反应：52%进展，40%稳定，8.0%部分缓解，0%完全缓解。多变量分析显示 T 分期、M 分期以及手术加新辅助化疗或手术加辅助治疗是独立的预后因素（P<0.05）。在匹配分析中，多变量模型显示与腺癌（风险比，2.38；95%CI，1.61-2.53）和鳞状细胞癌（风险比，2.20；95%CI，1.44-2.34）相比，PSC 的总生存率明显较差。
我们发现 PSC 的结果明显差于腺癌和鳞状细胞癌。除手术切除外，还应考虑新辅助或辅助化疗。
