Demographics and Clinicopathologic Profile of Pulmonary Sarcomatoid Carcinoma with Survival Analysis and Genomic Landscape

Asad Ullah; Asim Ahmed; Abdul Qahar Khan Yasinzai; Kue Tylor Lee; Israr Khan; Bina Asif; Imran Khan; Bisma Tareen; Kaleemullah Kakar; Gul Andam; Saleh Heneidi; Jaffar Khan; Hina Khan; Nabin R Karki; Jaydira Del Rivero; Nagla Abdel Karim

doi:10.3390/cancers15092469

Demographics and Clinicopathologic Profile of Pulmonary Sarcomatoid Carcinoma with Survival Analysis and Genomic Landscape

Cancers (Basel). 2023 Apr 26;15(9):2469. doi: 10.3390/cancers15092469.

Authors

Affiliations

¹ Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN 37232, USA.
² Medical College of Georgia, Augusta, GA 30912, USA.
³ Department of Medicine, Bolan Medical College, Quetta 83700, Pakistan.
⁴ Hackensack Meridian Health, Palisades Medical Center, North Bergen, NJ 07047, USA.
⁵ Bannu Medical College, Bannu 28100, Pakistan.
⁶ Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
⁷ Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
⁸ Division of Hematology and Oncology, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA.
⁹ Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA.
¹⁰ National Cancer Institute (NCI), Bethesda, MD 20892, USA.
¹¹ Inova Schar Cancer Institute, University of Virginia, Fairfax, VA 22031, USA.

Abstract

Background: Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC) with an aggressive clinical nature and poor prognosis. With novel targeted therapeutics being developed, new ways to effectively treat PSC are emerging. In this study, we analyze demographics, tumor characteristics, treatment modalities, and outcomes of PSC and genetic mutations in PSC. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database were reviewed to analyze cases of pulmonary sarcomatoid carcinoma from 2000 to 2018. The molecular data with the most common mutations in PSC were extracted from the Catalogue Of Somatic Mutations in Cancer (COSMIC) database. Results: A total of 5259 patients with PSC were identified. Most patients were between 70 and 79 years of age (32.2%), male (59.1%), and Caucasian (83.7%). The male-to-female ratio was 1.45:1. Most tumors were between 1 and 7 cm in size (69.4%) and poorly differentiated (grade III) (72.9%). The overall 5-year survival was 15.6% (95% confidence interval (95% CI) = 14.4-16.9)), and the cause-specific 5-year survival was 19.7% (95% CI = 18.3-21.1). The five-year survival for those treated with each modality were as follows: chemotherapy, 19.9% (95% CI = 17.7-22.2); surgery, 41.7% (95% CI = 38.9-44.6); radiation, 19.1% (95% CI = 15.1-23.5); and multimodality therapy (surgery and chemoradiation), 24.8% (95% CI = 17.6-32.7). On multivariable analysis, age, male gender, distant stage, tumor size, bone metastasis, brain metastasis, and liver metastasis were associated with increased mortality, and chemotherapy and surgery were associated with reduced mortality (p < 0.001). The best survival outcomes were achieved with surgery. The most common mutations identified in COSMIC data were TP53 31%, ARID1A 23%, NF1 17%, SMARCA4 16%, and KMT2D 9%. Conclusions: PSC is a rare and aggressive subtype of NSCLC, usually affecting Caucasian males between 70 and 79. Male gender, older age, and distant spread were associated with poor clinical outcomes. Treatment with surgery was associated with better survival outcomes.

Keywords: COSMIC; SEER; genetics; pulmonary sarcomatoid carcinoma; survival.

Grants and funding

This research received no external funding.