Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11005

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    P1.24-004 - Characteristics and Prognostic Analysis of Pulmonary Sarcomatoid Carcinoma (ID 727)

    09:30 - 09:30  |  Author(s): G. Xu
    • Abstract

    Background
    Pulmonary sarcomatoid carcinoma (PSC) is a group of rare tumor .The incidence in previous reports is from 0.1% to 4.7% of all lung malignancies. The recent 2004 WHO classification identified sarcomatoid carcinoma as a group of poorly differentiated non-small cell lung carcinomas that contained a component of sarcoma or sarcoma-like(spindle or giant cell or both) differentiation.There are 5 recognized subgroups: carcinosarcoma, spindle cell carcinoma, pleomorphic carcinoma, giant cell carcinoma, and pulmonary blastoma. Because of its rarity, the actual characteristics and prognosis of PSC is controversial. Some investigations reported PSC having a much more aggressive clinical course and significantly poorer outcome in comparison with other NSCLC, even when disease was diagnosed in early-stage.But others failed to show a poor prognosis for PSC.

    Methods
    We studied a cohort of 69 patients with PSC who received treatment in Sun Yat-sen University Cancer Center from January 1991 to December 2011 retrospectively.We analyzed the clinical characteristics, immunohistochemical profiles, epidermal growth factor receptor (EGFR) mutation status, K-RAS mutation status, treatments, and prognosis.

    Results
    PSC mainly occurred in young, male patients with a history of smoking. Eleven patients were stage I, 26 patients were stage Ⅱ, 23 patients were stage Ⅲ, and nine patients were stage IV at the time of initial diagnosis. The pathology of our patients included pleomorphic carcinoma (4 patients), spindle cell carcinoma (11 patients), giant cell carcinoma (10 patients), carcinosarcoma (34 patients), and pulmonary blastoma (10 patients).Most patients received multimodality treatments and the majority had early stage disease. Fifty patients achieved a complete resection while eleven patients achieved only an incomplete resections for a variety of reasones.Eight patients had inoperable disease when they were diagnosed.Among them, 5 received palliative chemotherapy alone.Eleven patients were tested for EGFR mutations, and all were wild type. Two patients tested for K-RAS mutations and identified 1 KRAS mutation.Five patients received EGFR tyrosine kinase inhibitor(EGFR-TKI) Gifitinib or Erlotinib as palliative salvage treatment: three patients maintained stable disease for 2,3,5 months with gefitinib, respectively; and the other two patients developed progressive disease after receiving treatment with erlotinib for 2 ,4 months , respectively. Median survival time (MST) was not reached, and the 5-year survival rate was 17.4%. Neither neo-adjuvant nor adjuvant chemotherapy improved patient survival for those with early stage disease. The patients without distant metastasis, with normal or higher BMI (≥18.5), with normal HGB, with smaller tumor size (≤4cm), and those who received complete resection had significantly better OS (p＜0.05). The patients with pleomorphic carcinoma had much worse prognosis. In a COX regression model, sex, smoking status, BMI, LDH, tumor size, N stage, M stage, pathology and having received a complete resection were independent prognostic factors (p＜0.05).

    Conclusion
    PSC is a unique lung malignancy with poor prognosis. Patients receiving complete resection had better prognosis, likely a reflection of early stage disease. Neither neo-adjuvant nor adjuvant chemotherapy improved patient survival for those with early stage disease. Future multi-center collaborations may be necessary to determine the optimal treatment.