Chen Cen, Ren Zhanliang, Dong Yujie, Wang Ying, Gao Yuan, Li Hongxia, Zhang Tongmei
Shaanxi University of Chinese Medicine, Xianyang 712000, China.
Department of Thoracic and Cardiac Surgery, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712000, China.
Zhongguo Fei Ai Za Zhi. 2024 Jul 20;27(7):514-522. doi: 10.3779/j.issn.1009-3419.2024.101.18.
Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC), which is featured by low incidence, high malignancy rate, robust aggressive behavior and inferior prognosis. To date, there is no standardized treatment. The aim of this study is to better understand and accumulate more clinical experience of the disease by summarizing the clinicopathological features, diagnosis methods, therapeutic regimen and prognostic factors of PSC.
A total of 39 patients with PSC who diagnosed and received treatment in Beijing Chest Hospital from December 2013 to December 2023 were retrospectively recruited, and information including demographic characteristics, clinicopathological features, tumor-node-metastasis (TNM) stage, diagnosis method and therapeutic regimen were carefully collected. Meanwhile, follow-up was conducted. Kaplan-Meier method was used to analyze the prognostic factors of the disease.
The PSC patients in this study ranged in age from 45 to 76 years old, including 35 males and 4 females. There were no specific clinical manifestations of PSC at initial diagnosis. Among the 39 patients, 20 underwent surgical resection and 19 received palliative chemoradiation or symptomatic supportive treatment. The 1-year and 5-year survival rates were 61.90% and 35.20% respectively. Univariate analysis indicated that family history of carcinoma, primary tumor site, TNM stage, lymph node metastasis, distant metastasis, whether or not received surgical resection, surgical method, treatment regimens, tumor tissue programmed cell death ligand 1 (PD-L1) expression ≥1% and mesenchymal-epithelial transition factor (MET) pathway abnormalities were correlated with the overall survival (OS) of patients (P<0.05). In the subsequent multivariate analysis, lymph node metastasis emerged as the only independent prognosticator in predicting inferior OS (P=0.037).
PSC is rarely seen in clinical practice and commonly occurs in elder men with smoking history. Tumor tissue PD-L1 expression ≥1% and MET abnormalities may predict inferior prognosis of PSC and lymph node metastasis was determined as the independent prognosticator of PSC. Surgical resection along with adjuvant medical treatment is the cornerstone for early and locally advanced patients, and the clinical utility of molecular targeting therapy and immunotherapy in PSC needs to be further investigated.
肺肉瘤样癌（PSC）是非小细胞肺癌（NSCLC）的一种罕见亚型，其特点是发病率低、恶性率高、侵袭性强且预后较差。迄今为止，尚无标准化治疗方案。本研究旨在通过总结PSC的临床病理特征、诊断方法、治疗方案及预后因素，更好地了解该疾病并积累更多临床经验。
回顾性纳入2013年12月至2023年12月在北京胸科医院诊断并接受治疗的39例PSC患者，仔细收集包括人口统计学特征、临床病理特征、肿瘤-淋巴结-转移（TNM）分期、诊断方法及治疗方案等信息。同时进行随访。采用Kaplan-Meier法分析该疾病的预后因素。
本研究中的PSC患者年龄在45至76岁之间，其中男性35例，女性4例。PSC初诊时无特异性临床表现。39例患者中，20例行手术切除，19例接受姑息性放化疗或对症支持治疗。1年和5年生存率分别为61.90%和35.20%。单因素分析表明，癌家族史、原发肿瘤部位、TNM分期、淋巴结转移、远处转移、是否接受手术切除、手术方式、治疗方案、肿瘤组织程序性细胞死亡配体1（PD-L1）表达≥1%及间充质-上皮转化因子（MET）通路异常与患者总生存期（OS）相关（P<0.05）。在随后的多因素分析中，淋巴结转移是预测OS较差的唯一独立预后因素（P=0.037）。
PSC在临床实践中少见，常见于有吸烟史的老年男性。肿瘤组织PD-L1表达≥1%及MET异常可能预示PSC预后较差，淋巴结转移被确定为PSC的独立预后因素。手术切除联合辅助治疗是早期和局部晚期患者的治疗基石，分子靶向治疗和免疫治疗在PSC中的临床应用有待进一步研究。
