Pathologic Findings and Long-Term Results After Surgical Treatment for Pulmonary Sarcomatoid Tumors: A Multicenter Analysis

Filippo Lococo, Cristian Rapicetta, Giuseppe Cardillo, Alessandro Stefani, Stefano Margaritora, Giovanni Leuzzi, Giulio Rossi, Leonardo Petracca Ciavarella, Uliano Morandi, Francesco Facciolo, Tommaso Ricchetti, Alfredo Cesario, Massimiliano Paci

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Abstract

Background: Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small cell lung cancer (NSCLC). The aim of this study was to clarify the pathologic characteristics and long-term survival after surgical treatment in patients with PSC. Methods: From January 2003 to December 2013, we retrospectively reviewed the clinical findings, surgical notes, and pathologic and follow-up data from 148 consecutive patients who underwent curative resection for PSC in 5 institutions. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used. Results: Mean age and male to female ratio were 66.6 ± 9.9 years and 120:28, respectively. Surgical resection (pneumonectomy in 8 patients, bilobectomy in 132 patients, and sublobar resection in 8 patients) was complete in 142 cases (96%). At pathologic evaluation, 36 patients (24%) had stage I, 69 patients (47%) had stage II, 33 patients (22%) had stage III, and 10 patients (7%) had stage IV disease. A "biphasic tumor" (PSC with an NSCLC component) was observed in 77 patients (52%). We detected a high rate of vascular emboli in the surgical specimens (overall, 68%; 57% in pathologic stage I tumors), whereas lymphatic emboli were found in 30% of cases (5% of pathologic stage I tumors). Overall median and 5-year long-term survival (LTS) was 19 months and 12.6% (LTS, 16.3% in pathologic stage I), respectively. Distant recurrences frequently occurred after surgical treatment (81%), even in pathologic stage I tumors that underwent R0 resection (62%). Multivariable survival analysis identified R+ resection (hazard ratio [HR],12.3; 95% confidence interval [CI], 3.67-41.28; . p < 0.0001), advanced pathologic stage (HR, 5.75; 95% CI, 2.55-12.98; . p < 0.0001), and the presence of vascular emboli (HR, 1.67; 95% CI, 1.05-2.67; . p = 0.0327) as independent negative prognostic factors. Conclusions: PSCs have very aggressive behavior and high metastatic potential even in early stages. R+ resection, pathologic TNM status, and the presence of vascular emboli are independent prognostic factors.

Original languageEnglish
JournalAnnals of Thoracic Surgery
DOIs
Publication statusAccepted/In press - 2016

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Lung
Neoplasms
Embolism
Carcinoma
Blood Vessels
Therapeutics
Confidence Intervals
Non-Small Cell Lung Carcinoma
Survival
Pneumonectomy
Survival Analysis
Regression Analysis
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Pathologic Findings and Long-Term Results After Surgical Treatment for Pulmonary Sarcomatoid Tumors : A Multicenter Analysis. / Lococo, Filippo; Rapicetta, Cristian; Cardillo, Giuseppe; Stefani, Alessandro; Margaritora, Stefano; Leuzzi, Giovanni; Rossi, Giulio; Petracca Ciavarella, Leonardo; Morandi, Uliano; Facciolo, Francesco; Ricchetti, Tommaso; Cesario, Alfredo; Paci, Massimiliano.

In: Annals of Thoracic Surgery, 2016.

Research output: Contribution to journalArticle

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title = "Pathologic Findings and Long-Term Results After Surgical Treatment for Pulmonary Sarcomatoid Tumors: A Multicenter Analysis",
abstract = "Background: Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small cell lung cancer (NSCLC). The aim of this study was to clarify the pathologic characteristics and long-term survival after surgical treatment in patients with PSC. Methods: From January 2003 to December 2013, we retrospectively reviewed the clinical findings, surgical notes, and pathologic and follow-up data from 148 consecutive patients who underwent curative resection for PSC in 5 institutions. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used. Results: Mean age and male to female ratio were 66.6 ± 9.9 years and 120:28, respectively. Surgical resection (pneumonectomy in 8 patients, bilobectomy in 132 patients, and sublobar resection in 8 patients) was complete in 142 cases (96{\%}). At pathologic evaluation, 36 patients (24{\%}) had stage I, 69 patients (47{\%}) had stage II, 33 patients (22{\%}) had stage III, and 10 patients (7{\%}) had stage IV disease. A {"}biphasic tumor{"} (PSC with an NSCLC component) was observed in 77 patients (52{\%}). We detected a high rate of vascular emboli in the surgical specimens (overall, 68{\%}; 57{\%} in pathologic stage I tumors), whereas lymphatic emboli were found in 30{\%} of cases (5{\%} of pathologic stage I tumors). Overall median and 5-year long-term survival (LTS) was 19 months and 12.6{\%} (LTS, 16.3{\%} in pathologic stage I), respectively. Distant recurrences frequently occurred after surgical treatment (81{\%}), even in pathologic stage I tumors that underwent R0 resection (62{\%}). Multivariable survival analysis identified R+ resection (hazard ratio [HR],12.3; 95{\%} confidence interval [CI], 3.67-41.28; . p < 0.0001), advanced pathologic stage (HR, 5.75; 95{\%} CI, 2.55-12.98; . p < 0.0001), and the presence of vascular emboli (HR, 1.67; 95{\%} CI, 1.05-2.67; . p = 0.0327) as independent negative prognostic factors. Conclusions: PSCs have very aggressive behavior and high metastatic potential even in early stages. R+ resection, pathologic TNM status, and the presence of vascular emboli are independent prognostic factors.",
author = "Filippo Lococo and Cristian Rapicetta and Giuseppe Cardillo and Alessandro Stefani and Stefano Margaritora and Giovanni Leuzzi and Giulio Rossi and {Petracca Ciavarella}, Leonardo and Uliano Morandi and Francesco Facciolo and Tommaso Ricchetti and Alfredo Cesario and Massimiliano Paci",
year = "2016",
doi = "10.1016/j.athoracsur.2016.08.114",
language = "English",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "The Society of Thoracic Surgeons. Published by Elsevier Inc",

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TY - JOUR

T1 - Pathologic Findings and Long-Term Results After Surgical Treatment for Pulmonary Sarcomatoid Tumors

T2 - A Multicenter Analysis

AU - Lococo, Filippo

AU - Rapicetta, Cristian

AU - Cardillo, Giuseppe

AU - Stefani, Alessandro

AU - Margaritora, Stefano

AU - Leuzzi, Giovanni

AU - Rossi, Giulio

AU - Petracca Ciavarella, Leonardo

AU - Morandi, Uliano

AU - Facciolo, Francesco

AU - Ricchetti, Tommaso

AU - Cesario, Alfredo

AU - Paci, Massimiliano

PY - 2016

Y1 - 2016

N2 - Background: Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small cell lung cancer (NSCLC). The aim of this study was to clarify the pathologic characteristics and long-term survival after surgical treatment in patients with PSC. Methods: From January 2003 to December 2013, we retrospectively reviewed the clinical findings, surgical notes, and pathologic and follow-up data from 148 consecutive patients who underwent curative resection for PSC in 5 institutions. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used. Results: Mean age and male to female ratio were 66.6 ± 9.9 years and 120:28, respectively. Surgical resection (pneumonectomy in 8 patients, bilobectomy in 132 patients, and sublobar resection in 8 patients) was complete in 142 cases (96%). At pathologic evaluation, 36 patients (24%) had stage I, 69 patients (47%) had stage II, 33 patients (22%) had stage III, and 10 patients (7%) had stage IV disease. A "biphasic tumor" (PSC with an NSCLC component) was observed in 77 patients (52%). We detected a high rate of vascular emboli in the surgical specimens (overall, 68%; 57% in pathologic stage I tumors), whereas lymphatic emboli were found in 30% of cases (5% of pathologic stage I tumors). Overall median and 5-year long-term survival (LTS) was 19 months and 12.6% (LTS, 16.3% in pathologic stage I), respectively. Distant recurrences frequently occurred after surgical treatment (81%), even in pathologic stage I tumors that underwent R0 resection (62%). Multivariable survival analysis identified R+ resection (hazard ratio [HR],12.3; 95% confidence interval [CI], 3.67-41.28; . p < 0.0001), advanced pathologic stage (HR, 5.75; 95% CI, 2.55-12.98; . p < 0.0001), and the presence of vascular emboli (HR, 1.67; 95% CI, 1.05-2.67; . p = 0.0327) as independent negative prognostic factors. Conclusions: PSCs have very aggressive behavior and high metastatic potential even in early stages. R+ resection, pathologic TNM status, and the presence of vascular emboli are independent prognostic factors.

AB - Background: Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small cell lung cancer (NSCLC). The aim of this study was to clarify the pathologic characteristics and long-term survival after surgical treatment in patients with PSC. Methods: From January 2003 to December 2013, we retrospectively reviewed the clinical findings, surgical notes, and pathologic and follow-up data from 148 consecutive patients who underwent curative resection for PSC in 5 institutions. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used. Results: Mean age and male to female ratio were 66.6 ± 9.9 years and 120:28, respectively. Surgical resection (pneumonectomy in 8 patients, bilobectomy in 132 patients, and sublobar resection in 8 patients) was complete in 142 cases (96%). At pathologic evaluation, 36 patients (24%) had stage I, 69 patients (47%) had stage II, 33 patients (22%) had stage III, and 10 patients (7%) had stage IV disease. A "biphasic tumor" (PSC with an NSCLC component) was observed in 77 patients (52%). We detected a high rate of vascular emboli in the surgical specimens (overall, 68%; 57% in pathologic stage I tumors), whereas lymphatic emboli were found in 30% of cases (5% of pathologic stage I tumors). Overall median and 5-year long-term survival (LTS) was 19 months and 12.6% (LTS, 16.3% in pathologic stage I), respectively. Distant recurrences frequently occurred after surgical treatment (81%), even in pathologic stage I tumors that underwent R0 resection (62%). Multivariable survival analysis identified R+ resection (hazard ratio [HR],12.3; 95% confidence interval [CI], 3.67-41.28; . p < 0.0001), advanced pathologic stage (HR, 5.75; 95% CI, 2.55-12.98; . p < 0.0001), and the presence of vascular emboli (HR, 1.67; 95% CI, 1.05-2.67; . p = 0.0327) as independent negative prognostic factors. Conclusions: PSCs have very aggressive behavior and high metastatic potential even in early stages. R+ resection, pathologic TNM status, and the presence of vascular emboli are independent prognostic factors.

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DO - 10.1016/j.athoracsur.2016.08.114

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