Poston Lauren M, Bassiri Aria, Jiang Boxiang, Boutros Christina, Sinopoli Jillian, Tapias Vargas Leonidas, Linden Philip A, Towe Christopher W
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
J Surg Res. 2023 Nov;291:380-387. doi: 10.1016/j.jss.2023.06.027. Epub 2023 Jul 27.
Sarcomatoid lung cancer has mainly been described in case series and single institution reviews. Although often associated with a poor prognosis, the overall survival compared to other forms of nonsmall cell lung cancer (NSCLC) is unknown. We hypothesize that sarcomatoid lung cancers have worse overall survival relative to other forms of NSCLC.
In this retrospective cohort study, we identified adult patients with nonmetastatic NSCLC from 2004 to 2018 in the National Cancer Database. Patients were categorized by histology as sarcomatoid, adenocarcinoma, or squamous cell carcinoma. We compared clinical and demographic characteristics between the groups. The primary outcome of overall survival was analyzed using Kaplan-Meier analysis. Multivariable Cox analysis was used to analyze factors associated with overall survival in sarcomatoid patients undergoing surgery.
Among 1,259,109 patients with lung cancer, there were 5223 (0.4%) sarcomatoid cancers. Sarcomatoid patients were more likely to be male, of Hispanic ethnicity, have fewer comorbidities, and receive treatment at an academic program. Despite higher cT- and M-stages, patients with sarcomatoid cancer were more likely to undergo surgical resection in multivariate analysis (odds ratio = 1.8 [confidence interval 1.60-2.11]; P < 0.001). Among nonmetastatic patients, overall survival was lower for sarcomatoid cancer relative to other histologies in Kaplan-Meier analysis (median survival sarcomatoid 17.6 mo versus nonsarcomatoid 31.5 mo, P < 0.001).
This National Cancer Database study confirms the findings of smaller studies that sarcomatoid cancer is associated with inferior overall survival compared to other NSCLCs. Given the inferior prognosis, further studies regarding optimal staging practices are appropriate.
肉瘤样肺癌主要在病例系列和单机构回顾中被描述。尽管其通常与预后不良相关，但与其他形式的非小细胞肺癌（NSCLC）相比，其总生存期尚不清楚。我们假设肉瘤样肺癌相对于其他形式的NSCLC具有更差的总生存期。
在这项回顾性队列研究中，我们在国家癌症数据库中识别了2004年至2018年的成年非转移性NSCLC患者。患者按组织学分类为肉瘤样、腺癌或鳞状细胞癌。我们比较了各组之间的临床和人口统计学特征。使用Kaplan-Meier分析对总生存期的主要结局进行分析。多变量Cox分析用于分析接受手术的肉瘤样患者中与总生存期相关的因素。
在1,259,109例肺癌患者中，有5223例（0.4%）为肉瘤样癌。肉瘤样患者更可能为男性、西班牙裔、合并症较少且在学术机构接受治疗。尽管cT和M分期较高，但在多变量分析中，肉瘤样癌患者更可能接受手术切除（比值比 = 1.8 [置信区间1.60 - 2.11]；P < 0.001）。在非转移性患者中，Kaplan-Meier分析显示肉瘤样癌的总生存期低于其他组织学类型（肉瘤样的中位生存期为17.6个月，非肉瘤样为31.5个月，P < 0.001）。
这项国家癌症数据库研究证实了较小规模研究的结果，即与其他NSCLC相比，肉瘤样癌与较差的总生存期相关。鉴于预后较差，关于最佳分期实践的进一步研究是合适的。
