Characteristics and Clinical Outcomes of Sarcomatoid Carcinoma of the Lung

Background Sarcomatoid carcinoma is a rare subtype of non–small-cell lung cancer, which has aggressive behavior. We present information on the clinicopathologic characteristics and clinical outcomes of these tumors. Patients and Methods From January 2000 to December 2012, the clinicopathologic data from 93 patients treated at 2 French cancer centers were retrospectively analyzed. A pathologic review was performed of all tumors. Results The patients were commonly male (77%), with a median age of 63 years and a history of smoking (84%). Most had symptoms, and about 70% presented with locally advanced or metastatic disease at diagnosis. Of the 93 cases, 41 were diagnosed by surgical resection. Pleomorphic carcinoma was the most common subtype (64%). With a median follow-up period of 30.7 months, the median survival of the patients who had undergone surgery was 16.4 months. Recurrence with distant metastases was common. Univariate analyses showed that advanced disease (pathologic stage > III) conferred a worse prognosis for recurrence-free and overall survival (P = .0024 and P < .0001, respectively). Twenty-eight patients received first-line chemotherapy for advanced disease. The progression rate was 72% at the first evaluation. The median time to progression and the median overall survival were poor (2.7 and 4.3 months, respectively). On univariate analysis, a platinum-based combination had significant influence on overall survival compared with monotherapy (P < .0001). Conclusion Sarcomatoid carcinoma is associated with a poor prognosis. Surgical treatment should be carefully considered in the early stages. The high resistance to chemotherapy emphasizes the need to test for new strategies through collaborative programs dedicated to this population.