Ann Thorac Surg 2007;84:981
© 2007 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited commentary
Mark K. Ferguson, MD
Department of Surgery, The University of Chicago Medical Center, 5841 S Maryland Ave, MC5035, Chicago, IL 60637
(Email: mferguso{at}surgery.bsd.uchicago.edu).
Notification from the surgical pathologist that a primary lung tumor contains spindle cells is normally met with disinterest on the part of the surgeon. This report will hopefully change that reaction. As Martin and colleagues [1] from MD Anderson Cancer Center explain, sarcomatoid lung cancers are a subset of nonsmall cell lung cancers containing more than 10% sarcomatoid elements in the presence of positive keratin markers. They conclusively demonstrate that such cancers, stage for stage, have substantially higher risk for both local and distant recurrence, leading to a worse prognosis despite aggressive therapy.
In the MD Anderson series spanning 20 years, resected sarcomatoid lung cancers comprised less than 2% of the cohort of patients undergoing any type of lung surgery for primary lung cancer. This represented fewer than 3 patients seen annually at this busy cancer center. Given the infrequent occurrence of sarcomatoid cancers, it is not surprising that physicians working at institutions with lower volumes of lung cancer lack familiarity with how to best manage these tumors.
Why should surgeons be interested in the nuances of management of such rare tumors? As these authors illustrate, the results of standard therapy for nonsmall cell lung cancer when applied to sarcomatoid lung cancers are unacceptably poor. The current push toward targeted therapy for lung cancer will find initial success in small populations of patients with shared characteristics such as race, sex, tobacco use, and specific gene alleles. It is incumbent upon surgeons to help identify unique populations of patients such as those with sarcomatoid cancers. This will enable the detailed study of such tumors, an effort that could lead to more successful directed therapy. Rather than finding unusual aspects of lung cancers pathology reports to be off-putting, these findings should be embraced as an opportunity to further our fight against the deadliest cancer killer in the world.
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- Martin LW, Correa AM, Ordonez NG, et al. Sarcomatoid carcinoma of the lung: a predictor of poor prognosis Ann Thorac Surg 2007;84:973-981.[Abstract/Free Full Text]
Related Article
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Sarcomatoid Carcinoma of the Lung: A Predictor of Poor Prognosis
- Linda W. Martin, Arlene M. Correa, Nelson G. Ordonez, Jack A. Roth, Stephen G. Swisher, Ara A. Vaporciyan, Garrett L. Walsh, and David C. Rice
Ann. Thorac. Surg. 2007 84: 973-980.
[Abstract]
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