Du Zhijuan, Qin Yuhui, Lv Yahui, Gao Jie, Chen Siyuan, Du Xiangyu, Li Tao, Hu Yi, Liu Zhefeng
Medical School of Chinese PLA, Beijing, China.
Department of Medical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
Clin Transl Oncol. 2024 Dec 25. doi: 10.1007/s12094-024-03823-8.
The clinicopathologic features, mutational status, immunohistochemical markers, and prognosis of Pulmonary sarcomatoid carcinoma (PSC) remain uncertain.
This study included 81 PSC and 337 lung adenocarcinomas (LUAD). Progression-free survival (PFS), overall survival (OS), and other clinical data were examined.
46% PSC patients harbored KRAS mutation and 23% harbored EGFR mutation. Univariable analysis identified type and cTNM stage as significant predictor of PFS (type: HR 0.216; 95% CI 0.133-0.349; P < 0.001, cTNM stage: HR 0.483; 95% CI 0.269-0.846; P = 0.014) and OS (type: HR 0.269; 95% CI 0.156-0.465; P < 0.001, cTNM stage: HR 0.435; 95% CI 0.219-0.865; P = 0.018). Multivariable analysis confirmed sex, type and cTNM stage as independent predictors of PFS (sex: HR 2.026; 95%CI 1.027-3.996; P = 0.042; type: HR0.140; 95% CI 0.083-0.238; P < 0.001, cTNM stage: HR0.305; 95% CI 0.165-0.564; P < 0.001) and OS (type: HR0.231; 95% CI 0.132-0.404; P < 0.001, cTNM stage: HR 0.394; 95% CI 0.194-0.797; P = 0.010). Significant differences in PFS (P < 0.0001) and OS (P = 0.022) were observed between PSC and LUAD, and for PC compared with SCC (PFS: P = 0.00036, OS: P = 0.0053). Additionally, PSC patients treated with immunotherapy showed significantly better OS (P = 0.0019) compared with those treated without immunotherapy.
PSC exhibits high KRAS and EGFR mutation rates, and spindle cell carcinoma has a worse prognosis. Immunotherapy shows potential as a treatment for advanced PSC.
肺肉瘤样癌（PSC）的临床病理特征、突变状态、免疫组化标志物及预后仍不明确。
本研究纳入81例PSC患者和337例肺腺癌（LUAD）患者。检测无进展生存期（PFS）、总生存期（OS）及其他临床数据。
46%的PSC患者存在KRAS突变，23%存在EGFR突变。单因素分析确定肿瘤类型和cTNM分期是PFS的显著预测因素（肿瘤类型：HR 0.216；95%CI 0.133 - 0.349；P＜0.001，cTNM分期：HR 0.483；95%CI 0.269 - 0.846；P = 0.014）和OS的显著预测因素（肿瘤类型：HR 0.269；95%CI 0.156 - 0.465；P＜0.001，cTNM分期：HR 0.435；95%CI 0.219 - 0.865；P = 0.018）。多因素分析证实性别、肿瘤类型和cTNM分期是PFS的独立预测因素（性别：HR 2.026；95%CI 1.027 - 3.996；P = 0.042；肿瘤类型：HR0.140；95%CI 0.083 - 0.238；P＜0.001，cTNM分期：HR0.305；95%CI 0.165 - 0.564；P＜0.001）和OS的独立预测因素（肿瘤类型：HR0.231；95%CI 0.132 - 0.404；P＜0.001，cTNM分期：HR 0.394；95%CI 0.194 - 0.797；P = 0.010）。PSC和LUAD之间在PFS（P＜0.0001）和OS（P = 0.022）方面观察到显著差异，且PC与SCC相比（PFS：P = 0.00036，OS：P = 0.0053）也有显著差异。此外，接受免疫治疗的PSC患者与未接受免疫治疗的患者相比，OS显著更好（P = 0.0019）。
PSC显示出高KRAS和EGFR突变率，梭形细胞癌预后更差。免疫治疗显示出作为晚期PSC治疗方法的潜力。
