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Ann Thorac Surg 2007;84:973-980
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Sarcomatoid Carcinoma of the Lung: A Predictor of Poor Prognosis

^a Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
^b Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Accepted for publication March 26, 2007.

^_* Address correspondence to Dr Rice, Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 445, Houston, TX 77030 (Email: drice{at}mdanderson.org).

Background: Sarcomatoid cancer (SARC) of the lung is a rare histologic type of non-small cell lung cancer (NSCLC). Although believed to be associated with poor prognosis, its effect on survival and recurrence has not been well defined. Our goal was to determine the prognostic significance of SARC histology in patients undergoing pulmonary resection.

Methods: We retrospectively evaluated all patients who underwent pulmonary resection for NSCLC during a 20-year period at the University of Texas MD Anderson Cancer Center and compared recurrence and survival rates of patients with SARC with a cohort of patients with typical NSCLC. To account for known prognostic factors such as smoking status, age, gender, pathologic stage, and adjuvant therapy, we used one-to-one matching based on propensity scores.

Results: The study included 63 SARC patients and 1133 NSCLC patients with complete data. Propensity score matching identified 63 NSCLC patients that were similar to the 63 SARC patients from known clinical factors. The 5-year survival for SARC patients was 24.5% compared with 46.3% for NSCLC patients (p = 0.01); median time to recurrence was 11.3 months and 61.4 months, respectively (p = 0.001).

Conclusions: Compared with other histologic subtypes, SARC behaves in an aggressive fashion. These tumors are frequently symptomatic, are locally advanced, and have higher rates of recurrence. Future investigation of novel treatment approaches is warranted. Nonsurgical treatment modalities may be appropriate for patients with clinically advanced disease.

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Invited commentary

Mark K. Ferguson
Ann. Thorac. Surg. 2007 84: 981. [Extract] [Full Text] [PDF]

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