Clinical characteristics and survival outcomes in patients with pulmonary sarcomatoid carcinoma: a multicenter retrospective study

The clinicopathologic features, mutational status, immunohistochemical markers, and prognosis of Pulmonary sarcomatoid carcinoma (PSC) remain uncertain.

This study included 81 PSC and 337 lung adenocarcinomas (LUAD). Progression-free survival (PFS), overall survival (OS), and other clinical data were examined.

46% PSC patients harbored KRAS mutation and 23% harbored EGFR mutation. Univariable analysis identified type and cTNM stage as significant predictor of PFS (type: HR 0.216; 95% CI 0.133–0.349; P < 0.001, cTNM stage: HR 0.483; 95% CI 0.269–0.846; P = 0.014) and OS (type: HR 0.269; 95% CI 0.156–0.465; P < 0.001, cTNM stage: HR 0.435; 95% CI 0.219–0.865; P = 0.018). Multivariable analysis confirmed sex, type and cTNM stage as independent predictors of PFS (sex: HR 2.026; 95%CI 1.027–3.996; P = 0.042; type: HR0.140; 95% CI 0.083–0.238; P < 0.001, cTNM stage: HR0.305; 95% CI 0.165–0.564; P < 0.001) and OS (type: HR0.231; 95% CI 0.132–0.404; P < 0.001, cTNM stage: HR 0.394; 95% CI 0.194–0.797; P = 0.010). Significant differences in PFS (P < 0.0001) and OS (P = 0.022) were observed between PSC and LUAD, and for PC compared with SCC (PFS: P = 0.00036, OS: P = 0.0053). Additionally, PSC patients treated with immunotherapy showed significantly better OS (P = 0.0019) compared with those treated without immunotherapy.

PSC exhibits high KRAS and EGFR mutation rates, and spindle cell carcinoma has a worse prognosis. Immunotherapy shows potential as a treatment for advanced PSC.