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Wu W, Zheng L, Li F, Chen H, Huang C, Chen Q, Lin Y, Xu X, Dai Y. Survival analysis and nomogram for pulmonary sarcomatoid carcinoma: an SEER analysis and external validation. BMJ Open 2023; 13:e072260. [PMID: 37848302 PMCID: PMC10583103 DOI: 10.1136/bmjopen-2023-072260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Uncommon and particularly deadly, pulmonary sarcomatoid carcinoma (PSC) is an aggressive type of lung cancer. This research aimed to create a risk categorisation and nomogram to forecast the overall survival (OS) of patients with PSC. METHODS To develop the model, 899 patients with PSC were taken from the Surveillance, Epidemiology, and End Results database from the USA. We also used an exterior verification sample of 34 individuals with PSC from Fujian Provincial Hospital in China. The Cox regression hazards model and stepwise regression analysis were done to screen factors in developing a nomogram. The nomogram's ability to discriminate was measured employing the area under a time-dependent receiver operating characteristic curve (AUC), the concordance index (C-index) and the calibration curve. Decision curve analysis (DCA) and integrated discrimination improvement (IDI) were used to evaluate the nomogram to the tumour-node-metastasis categorisation developed by the American Joint Committee on Cancer (AJCC-TNM), eighth edition, and an additional sample confirmed the nomogram's accuracy. We further developed a risk assessment system based on nomogram scores. RESULTS Six independent variables, age, sex, primary tumour site, pathological group, tumour-node-metastasis (TNM) clinical stage and therapeutic technique, were chosen to form the nomogram's basis. The nomogram indicated good discriminative ability with the C-index (0.763 in the training cohort and 0.746 in the external validation cohort) and time-dependent AUC. Calibration plots demonstrated high congruence between the prediction model and real-world evidence in both the validation and training cohorts. Nomogram outperformed the AJCC-TNM eighth edition classification in both DCA and IDI. Patients were classified into subgroups according to their risk ratings, and significant differences in OS were observed between them (p<0.001). CONCLUSION We conducted a survival analysis and nomogram for PSC. This developed nomogram holds potential to serve as an efficient tool for clinicians in prognostic modelling.
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Affiliation(s)
- Weishuai Wu
- Shengli Clinical Medical College of Fujian Medical University,Fujian Provinical Hospital, Fuzhou, Fujian, China
| | - Lijing Zheng
- Shengli Clinical Medical College of Fujian Medical University,Fujian Provinical Hospital, Fuzhou, Fujian, China
- Departments of Oncology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Feng Li
- Shengli Clinical Medical College of Fujian Medical University,Fujian Provinical Hospital, Fuzhou, Fujian, China
- Departments of Pathology, Fujian Provincial Hospital, Fuzhou, China
| | - Hongchao Chen
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Chen Huang
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Qianshun Chen
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yidan Lin
- Shengli Clinical Medical College of Fujian Medical University,Fujian Provinical Hospital, Fuzhou, Fujian, China
| | - Xunyu Xu
- Shengli Clinical Medical College of Fujian Medical University,Fujian Provinical Hospital, Fuzhou, Fujian, China
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yongmei Dai
- Shengli Clinical Medical College of Fujian Medical University,Fujian Provinical Hospital, Fuzhou, Fujian, China
- Departments of Oncology, Fujian Provincial Hospital, Fuzhou, Fujian, China
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Tang W, Wen C, Pei Y, Wu Z, Zhong J, Peng J, Zhong J. Preoperative CT findings and prognosis of pulmonary sarcomatoid carcinoma: comparison with conventional NSCLC of similar tumor size. BMC Med Imaging 2023; 23:105. [PMID: 37580691 PMCID: PMC10424330 DOI: 10.1186/s12880-023-01065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC) but differs in terms of treatment strategies compared with conventional-NSCLC (c-NSCLC). However, preoperative CT differentiation between PSC and c-NSCLC remains a challenge. This study aimed to explore the CT findings and prognosis of PSC compared with c-NSCLC of similar tumor size. METHODS Clinical data and CT findings of 31 patients with PSC and 87 patients with c-NSCLC were retrospectively analyzed. Clinical data included sex, age, and smoking history. CT findings included tumor size, tumor location, calcification, vacuole/cavity, pleural invasion, mean CT value, and low-attenuation area (LAA) ratio. Kaplan‒Meier curves and log-rank tests were used for survival analysis. A Cox regression model was constructed to evaluate prognostic risk factors associated with overall survival (OS). The Spearman correlation among clinicoradiological outcomes were analyzed. RESULTS The mean tumor size of PSC and c-NSCLC were both 5.1 cm. The median survival times of PSC and c-NSCLC were 8 months and 34 months, respectively (P < 0.001). Calcification and vacuoles/cavities were rarely present in PSC. Pleural invasion occurred in both PSC and c-NSCLC (P = 0.285). The mean CT values of PSC and c-NSCLC on plain scan (PS), arterial phase (AP), and venous phase (VP) were 30.48 ± 1.59 vs. 36.25 ± 0.64 Hu (P = 0.002), 43.26 ± 2.96 vs. 58.71 ± 1.65 Hu (P < 0.001) and 50.26 ± 3.28 vs. 64.24 ± 1.86 Hu (P < 0.001), the AUCs were 0.685, 0.757 and 0.710, respectively. Compared to c-NSCLC, PSC had a larger LAA ratio, and the AUC was 0.802, with an optimal cutoff value of 20.6%, and the sensitivity and specificity were 0.645 and 0.862, respectively. Combined with the mean CT value and LAA ratio, AP + VP + LAA yielded the largest AUC of 0.826. The LAA ratio were not independent risk factors for PSC in this study. LAA ratio was negatively correlated with PS (r = -0.29), AP (r = -0.58), and VP (r = -0.66). LAA showed a weak positive correlation with tumor size(r = 0.27). CONCLUSIONS PSC has a poorer prognosis than c-NSCLC of similar tumor size. The mean CT value and LAA ratio contributes to preoperative CT differentiation of PSC and c-NSCLC.
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Affiliation(s)
- Wenjian Tang
- Department of Medical Imaging, Ganzhou People's Hospital, The Affiliated Ganzhou Hospital of Nanchang University, 16th Meiguan Avenue, Ganzhou, 341000, P.R. China
| | - Chunju Wen
- Department of Medical Hematology, Ganzhou People's Hospital, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| | - Yixiu Pei
- Department of Medical Imaging, Ganzhou People's Hospital, The Affiliated Ganzhou Hospital of Nanchang University, 16th Meiguan Avenue, Ganzhou, 341000, P.R. China
| | - Zhen Wu
- Department of Pathology, Ganzhou People's Hospital, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| | - Junyuan Zhong
- Department of Medical Imaging, Ganzhou People's Hospital, The Affiliated Ganzhou Hospital of Nanchang University, 16th Meiguan Avenue, Ganzhou, 341000, P.R. China
| | - Jidong Peng
- Department of Medical Imaging, Ganzhou People's Hospital, The Affiliated Ganzhou Hospital of Nanchang University, 16th Meiguan Avenue, Ganzhou, 341000, P.R. China
| | - Jianping Zhong
- Department of Medical Imaging, Ganzhou People's Hospital, The Affiliated Ganzhou Hospital of Nanchang University, 16th Meiguan Avenue, Ganzhou, 341000, P.R. China.
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Huang L, Huang T, Li L, Feng A, He N, Li S, Lyu J. Factors Associated With Lymph Node Yield and Effects of Lymph Node Density on Survival of Patients With Pulmonary Sarcomatoid Carcinoma. Am J Clin Oncol 2022; 45:458-464. [PMID: 36256867 PMCID: PMC9624378 DOI: 10.1097/coc.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this study was to identify factors associated with lymph node yield (LNY) during surgeries for pulmonary sarcomatoid carcinoma (PSC) and to determine effects of lymph node density (LND) on the overall survival (OS) of patients with PSC. MATERIALS AND METHODS The SEER Research Plus database was searched for data on patients with PSC from 1988 to 2018. Poisson regression was used of all patients with PSC to identify relevant factors associated with LNY. Univariate and multivariate Cox regression analyses were adopted for lymph node (LN)-positive patients to evaluate the impact of LND on OS. The 5-year OS rates of patients with PSC were compared based on their LN status and LND. RESULTS There were 545 eligible patients in the study sample, 175 of which were LN-positive. These patients had significantly lower 5-year OS than those with no positive LNs ( P <0.001). Poisson regression analysis indicated relevant factors increasing LNY included higher diagnosis age, non-Hispanic American Indian or Alaska Native races, larger tumor, pleomorphic carcinoma histology, and more advanced disease stages. The Cox regression analysis indicated higher LND ( P =0.022) was probably associated with a worse prognosis for LN-positive patients. The group with LND ≥0.12 had a higher risk of death than the group with LND <0.12 ( P <0.001) among LN-positive patients with PSC. CONCLUSIONS Patients with PSC with high LND experienced worse outcomes than those with low LND. Further risk stratification of patients with PSC may help to improve survival benefits based on prognostic indicators of LND.
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Affiliation(s)
- Liying Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou
| | - Aozi Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou
| | - Ningxia He
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou
| | - Shuna Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization Guangzhou, Guangdong Province, China
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Zou RQ, Hu HJ, Lv TR, Liu F, Ma WJ, Wang JK, Dai YS, Yang SQ, Hu YF, Li FY. Clinicopathological characteristics and outcome of primary sarcomatoid carcinoma of the gallbladder. Front Oncol 2022; 12:1009673. [PMID: 36248964 PMCID: PMC9562585 DOI: 10.3389/fonc.2022.1009673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeOur study aims to examine the clinicopathological features, disease progression, management, and outcomes of gallbladder sarcomatoid carcinoma (GBSC) patients.MethodsBetween January 2000 and December 2020, 50 gallbladder cancer (GBC) patients who received surgical treatment and were pathologically verified as GBSC at our institution were enrolled. The clinical and pathological features and survival of these patients were retrospectively reviewed.ResultsThe median overall survival (OS) of GBSC patients was 14.5 months, and the 1-, 2- and 3-year OS rates were 68.0%, 32.0%, and 10.0%, respectively. The median progression-free survival (PFS) was 10.0 months, and the 1-, 2-, and 3-year PFS rates were 42.0%, 16.0%, and 2.0%, respectively. Patients who received radical resection had obviously better OS (18.0 vs. 7.0 months, P<0.001) and PFS (12.0 vs. 5.0 months, P<0.001) than those who underwent palliative resection. Multivariate analysis revealed that vascular invasion (P=0.033), curative operation (P<0.001) and postoperative chemotherapy (P=0.033) were independent risk factors for PFS. We further identified postoperative chemotherapy (P=0.010) and curative operation (P<0.001) as independent prognostic factors affecting the OS of GBSC patients. After curative surgery, patients who underwent S-1-based chemotherapy showed significantly longer recurrence-free survival (RFS) than those who underwent other chemotherapy regimens (20.0 vs 11.0 months, P=0.028).ConclusionGBSC patients always have aggressive biological behaviors and remarkably poor prognoses. Most GBSC patients are diagnosed in advanced stages, and timely radical operation together with postoperative chemotherapy is important. S-1-based chemotherapy may be a selectively efficient regimen to prolong the survival of GBSC patients.
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Wang Y, Yang L, Wang J, Gui L, Li W, Liu Z, Ma X, Yang Y, Wang L, Bi N. Case Report: First Case of Consolidation Immunotherapy After Definitive Chemoradiotherapy in Mediastinal Lymph Node Metastatic Sarcomatoid Carcinoma. Front Oncol 2022; 11:788856. [PMID: 35083145 PMCID: PMC8785342 DOI: 10.3389/fonc.2021.788856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Sarcomatoid carcinoma (SC) is a rare lung cancer subtype with poor prognosis and lack of effective treatment regimens. Studies concerning SC indicated common programmed death ligand-1 (PD-L1) overexpression and higher tumor mutational burden, leading to potential benefits from immunotherapy. The present case is the first report employing PD-L1 inhibitor durvalumab following definitive concurrent chemoradiotherapy (cCRT) in a patient with mediastinal lymph node metastatic SC, which was considered as a high probability of pulmonary origin but unclear primary lesion. After the 19-month follow-up, there was neither local recurrence nor distant metastasis. The patient was in a good condition, with the thoracic lesion controlled at Partial response-Response Evaluation Criteria in Solid Tumors (PR-RECIST). Except for grade 2 esophagitis, none of the other adverse events was observed. Our first attempt to adopt the consolidation immunotherapy after cCRT in unresectable locally advanced mediastinal SC exhibited improved local control, manageable safety, and potential survival benefits, representing a novel and promising therapeutic option for SC and encouraging further research exploration of this regimen in the future.
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Affiliation(s)
- Yu Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Wei Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhiqiang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiangyu Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yin Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Guo MN, Jalil A, Liu JY, Miao RY, Tran TA, Guan J. Tongue swelling as a manifestation of tongue metastasis from pulmonary sarcomatoid carcinoma: A case report. World J Clin Oncol 2021; 12:282-289. [PMID: 33959481 PMCID: PMC8085509 DOI: 10.5306/wjco.v12.i4.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcomatoid carcinoma is a rare subtype of non-small-cell lung cancer, commonly associated with locally advanced disease, early metastasis, and poor prognosis. Tongue metastasis from lung cancer is a rare condition that may occur in advanced stage of the disease.
CASE SUMMARY The patient was a 70-year-old female with a history of resected pulmonary sarcomatoid carcinoma (PSC) who presented with subacute tongue swelling, imparting the clinical impression of a lingual abscess. However, histologic examination of the partial glossectomy revealed a high-grade, poorly differentiated spindle and epithelioid carcinoma consistent with metastatic PSC.
CONCLUSION Although uncommon, clinicians should be cognizant of the possibility of a metastatic process to the tongue mimicking a benign or inflammatory process. A high index of suspicion for metastatic disease should be maintained when tongue swelling is observed in patients with a known history of PSC.
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Affiliation(s)
- Meng-Ni Guo
- Department of Internal Medicine, AdventHealth Orlando, Orlando, FL 32804, United States
| | - Anum Jalil
- Department of Internal Medicine, AdventHealth Orlando, Orlando, FL 32804, United States
| | - Jie-Ying Liu
- Department of Internal Medicine, AdventHealth Orlando, Orlando, FL 32804, United States
| | - Ruo-Yu Miao
- Department of Internal Medicine, AdventHealth Orlando, Orlando, FL 32804, United States
| | - Tien Anh Tran
- Department of Pathology, AdventHealth Orlando, Orlando, FL 32804, United States
| | - Jian Guan
- Department of Internal Medicine, AdventHealth Orlando, Orlando, FL 32804, United States
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Commentary: Resected pulmonary sarcomatoid carcinoma-a defined treatment paradigm, or just the end of the beginning of the search? J Thorac Cardiovasc Surg 2021; 163:1683-1684. [PMID: 33812685 DOI: 10.1016/j.jtcvs.2021.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/24/2022]
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Lu Y, Yu S, Wang G, Ma Z, Fu X, Cao Y, Li Q, Xu Z. Elevation of EIF4G1 promotes non-small cell lung cancer progression by activating mTOR signalling. J Cell Mol Med 2021; 25:2994-3005. [PMID: 33523588 PMCID: PMC7957198 DOI: 10.1111/jcmm.16340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/30/2020] [Accepted: 01/12/2021] [Indexed: 01/04/2023] Open
Abstract
Eukaryotic translation initiation factor 4 gamma 1 (EIF4G1), as the key component of the transcription initiation factor complex EIF4F, is significantly upregulated in multiple solid tumours, including lung cancer. However, the function and mechanism of EIF4G1 in the regulation of non‐small‐cell lung cancer (NSCLC) remain unclear. Here, using the clinical samples and the comprehensive survival analysis platforms Kaplan‐Meier plotter, we observed aberrant upregulation of EIF4G1 in NSCLC tissues; furthermore, high expression of EIF4G1 showed association with low differentiation of lung cancer cells and poor overall survival in NSCLC patients. Non‐small‐cell lung cancer cell line A549 and H1703 stably infected with EIF4G1 shRNA were used to determine the function of EIF4G1 in regulating cell proliferation and tumorigenesis in vitro and in vivo. The results demonstrated that EIF4G1 promoted the G1/S transition of the cell cycle and tumour cell proliferation in non‐small cell lung cancer. Mechanistically, EIF4G1 was found to regulate the expression and phosphorylation of mTOR (Ser2448), which mediates the tumorigenesis‐promoting function of EIF4G1. The inhibition of mTOR attenuated the EIF4G1‐induced development and progression of tumours. These findings demonstrated that EIF4G1 is a new potential molecular target for the clinical treatment of non‐small cell lung cancer.
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Affiliation(s)
- Ying Lu
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shanshan Yu
- Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangxue Wang
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zuan Ma
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuelian Fu
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yueyu Cao
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qinchuan Li
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zengguang Xu
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Li XM, Jin LB. Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature. World J Clin Cases 2021; 9:379-388. [PMID: 33521105 PMCID: PMC7812883 DOI: 10.12998/wjcc.v9.i2.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal metastases are common in patients with malignancies, but studies on those metastasized from unknown primaries are scarce due to the difficulty in treatment and the relatively poor prognosis. Knowledge of surgical complications, particularly perioperative mortality, in patients with spinal metastases from unidentified sources is still insufficient. CASE SUMMARY A 54-year-old man with chest-back pain was diagnosed with spinal metastasis in the seventh thoracic vertebra (T7). Radiographic examinations, as well as needle biopsy and immunohistochemical tests were performed to verify the characteristics of the lesion, resulting in an inconclusive diagnosis of poorly differentiated cancer from an unknown primary lesion. Therefore, spinal surgery was performed using the posterior approach to relieve symptoms and verify the diagnosis. Postoperative histologic examination indicated that this poorly differentiated metastatic cancer was possibly sarcomatoid carcinoma. As the patient experienced unexpectedly fast progression of the disease and died 16 d after surgery, the origin of this metastasis was undetermined. We discuss this case with respect to reported perioperative mortality in similar cases. CONCLUSION A comprehensive assessment prior to surgical decision-making is essential to reduce perioperative mortality risk in patients with spinal metastases from an unknown origin.
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Affiliation(s)
- Xiu-Mao Li
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Li-Bin Jin
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Liang X, Cheng Y, Yuan Z, Yan Z, Li Q, Huang Y, Feng G. Clinical, pathological and treatment factors associated with the survival of patients with pulmonary sarcomatoid carcinoma. Oncol Lett 2020; 19:4031-4039. [PMID: 32382345 PMCID: PMC7202303 DOI: 10.3892/ol.2020.11472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a group of five rare non-small cell lung cancer subtypes. In the present study, the clinical characteristics and outcomes of patients with PSC registered in the Surveillance, Epidemiology and End Results (SEER) database were investigated. For this purpose, data for patients with PSC (n=1,723) who received their initial diagnosis between 1988 and 2016 were collected from the SEER database. Survival analysis was performed using the Kaplan-Meier curves and the log-rank test. Subsequently, multivariate analyses with the Cox proportional hazards model were used to identify significant independent predictors. A nomogram model was established to predict survival performance using the concordance index (C-index). From the total cohort, patients with pulmonary blastoma demonstrated improved 1-year overall survival (OS) rate compared with other pathological types (P<0.001). The 2-year overall survival rates of the ‘only radiotherapy’ cohort and the ‘no specific treatment’ cohort were 9.1 and 5.4% (P<0.001), respectively. Radiotherapy significantly improved the OS rate in stage I–III patients with PSC (P<0.001) when stratified by stage. After matching the propensity scores, the ‘surgery combined with radiotherapy’ group comprised 156 patients and the ‘surgery-only’ group had 247 patients (1:1.6). However, no significant differences in prognosis were found between the 2 subgroups (P=0.052). The multivariate Cox analysis demonstrated that older age (≥76 years old), male, unmarried, pathological type, larger tumor size (≥56 mm), later tumor node metastasis stages and treatment modalities were independent prognostic factors. A nomogram model was established to predict the survival of patients with PSC. This model incorporated the seven aforementioned independent prognostic factors (C-index for survival, 0.75; 95% confidence interval, 0.74–0.76). Radiotherapy needs to considered for stage I–III patients with PSC who undergo radiation therapy without surgical resection.
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Affiliation(s)
- Xiaohong Liang
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Yinan Cheng
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Zijiang Yuan
- Department of Ear, Nose and Throat, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Zhengping Yan
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Quqing Li
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Yuan Huang
- Department of Cardiovascular Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Gaohua Feng
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
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LuLu X, Jian S. Concomitance of pulmonary spindle cell carcinoma and sclerosing pneumocytoma in a woman: A case report. Medicine (Baltimore) 2019; 98:e18416. [PMID: 31861007 PMCID: PMC6940139 DOI: 10.1097/md.0000000000018416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Pulmonary spindle cell carcinoma (PSCC) is a rare subset of pulmonary sarcomatoid carcinoma. PSCC is aggressive and has a poor prognosis. Pulmonary sclerosing pneumocytoma (PSP) is an asymptomatic slow-growing benign tumor, which usually occurs in middle-aged women. PATIENT CONCERNS Herein, we report a case of solitary PSCC, occurring concomitantly with PSP in a 74-year-old woman. The patient visited our institution with productive purulent cough, dyspnea after activity, and hemoptysis. Enhanced computed tomography revealed an inhomogeneous enhanced mass with central low-attenuation in the right upper lobe (RUL). The mass located in the right lower lobe (RLL) exhibited homogeneous enhancement. DIAGNOSIS These lesions were subsequently diagnosed as PSCC in the RUL and PSP in the RLL, following postoperative pathological examination. INTERVENTIONS We performed lobectomy for the RUL and wedge resection for the RLL in one procedure. OUTCOMES The patient did not experience complications after surgery. No radiological evidence of recurrence was observed on follow-up computed tomography performed within 7 months after the procedure. LESSONS This case fully reflects the importance of the differential preoperative diagnosis of benign and malignant solitary pulmonary nodules. However, a rare and aggressive malignant tumor may have imaging features typical of a lung abscess, which should be treated carefully.
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Liu J, Xiao M, Wang Y. Oral sarcomatoid squamous cell carcinoma: a retrospective study based on 14 cases. Histol Histopathol 2019; 35:385-394. [PMID: 31642511 DOI: 10.14670/hh-18-176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The treatment outcomes for oral sarcomatoid squamous cell carcinoma (OSSCC) are far from satisfactory in our hospital. The aim of this study was to retrospectively summarize the OSSCC cases admitted to our department. From 2003 to 2017, 14 patients were hospitalized and diagnosed with OSSCC. We summarized and analysed the medical histories, diagnostic examinations, treatment strategies, and clinical outcomes of the involved cases. Of the 14 cases, 8 were located in the gingiva. The imageological diagnosis identified the existence of a mass with an infiltrative morphology pre-operatively. The cytopathologic features revealed a malignant neoplasm with a mixture of squamous cell carcinoma (SCC) components and spindle cell neoplastic components. To confirm the diagnosis of OSSCC, the use of the immunohistochemical markers AE1/AE3 and Vimentin were more indicative. Complete follow-up data were available for 12 patients, and at the last follow-up, all 12 of the patients had died. The median overall survival for these patients was 11.67 months (range: 3-24 months). OSSCC patients respond poorly to the strategies solely referring to experiences from oral squamous cell carcinoma (OSCC) treatment. The effective diagnosis and treatment of OSSCC at an early stage is necessary. The treatment for OSSCC still poses a great challenge for clinical oncologists.
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Affiliation(s)
- Jialiang Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Meng Xiao
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.,Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
| | - Yan'an Wang
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.,Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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Qin Z, Huang B, Yu G, Zheng Y, Zhao K. Gingival metastasis of a mediastinal pulmonary sarcomatoid carcinoma: a case report. J Cardiothorac Surg 2019; 14:161. [PMID: 31500651 PMCID: PMC6734495 DOI: 10.1186/s13019-019-0991-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/04/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Pulmonary sarcomatoid carcinoma (PSC) is a rare malignancy with both epithelial and sarcoma components, and high tumor metastasis potential. CASE PRESENTATION A 63-year-old male patient had a tumor in the right posterior mediastinum, and was eventually diagnosed with PSC and gingival metastasis. The patient underwent thoracoscopic right upper pneumonectomy with lymph node dissections, and the subsequent gingival biopsy revealed a metastatic PSC. The immunohistochemistry revealed that both PSC site tissues were positive for vimentin, CKAE1/AE3 and Ki-67. The patient received radiotherapy and chemotherapy after surgery, and deceased two months later due to systemic tumor metastases. CONCLUSION PSC metastasis is variable, and leads to diagnostic dilemma or erroneous diagnosis. A differential diagnosis can help to distinguish it from gingival cancer.
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Affiliation(s)
- Zhonghua Qin
- Department of Cardiothoracic Surgery, The affiliated Jiangyin People’s Hospital of Southeast University Medical College, 3 Yingrui Road, Jiangyin, 214400 Jiangsu China
| | - Bin Huang
- Department of Cardiothoracic Surgery, The affiliated Jiangyin People’s Hospital of Southeast University Medical College, 3 Yingrui Road, Jiangyin, 214400 Jiangsu China
| | - Guiping Yu
- Department of Cardiothoracic Surgery, The affiliated Jiangyin People’s Hospital of Southeast University Medical College, 3 Yingrui Road, Jiangyin, 214400 Jiangsu China
| | - Yongqiang Zheng
- Department of Radiology, The affiliated Jiangyin People’s Hospital of Southeast University Medical College, 3 Yingrui Road, Jiangyin, 214400 Jiangsu China
| | - Ke Zhao
- Department of Pathology, The affiliated Jiangyin People’s Hospital of Southeast University Medical College, 3 Yingrui Road, Jiangyin, 214400 Jiangsu China
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Hou J, Xing L, Yuan Y. A clinical analysis of 114 cases of sarcomatoid carcinoma of the lung. Clin Exp Med 2018; 18:555-562. [DOI: 10.1007/s10238-018-0517-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/05/2018] [Indexed: 02/02/2023]
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