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Vieira T, Antoine M, Ruppert AM, Fallet V, Duruisseaux M, Giroux Leprieur E, Poulot V, Rabbe N, Sclick L, Beau-Faller M, Lacave R, Lavole A, Cadranel J, Wislez M. Blood vessel invasion is a major feature and a factor of poor prognosis in sarcomatoid carcinoma of the lung. Lung Cancer 2014; 85:276-81. [PMID: 24997135 DOI: 10.1016/j.lungcan.2014.06.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/30/2014] [Accepted: 06/08/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Pulmonary sarcomatoid carcinomas (SC) are highly disseminated types of non-small-cell lung carcinoma. Their prognosis is poor. New therapeutic targets are needed to improve disease management. MATERIALS AND METHODS From 1995 to 2013, clinical and survival data from all consecutive patients with surgically treated SC were collected. Pathological and biomarker analyses were performed: TTF1, P63, c-MET and ALK expression (immunohistochemistry), PAS staining, ALK rearrangement (FISH), and EGFR, KRAS, HER2, BRAF, PIK3CA, and MET genes mutations (PCR). RESULTS Seventy-seven patients were included. Median age was 61 years (53-69). Histological subtypes were pleomorphic carcinoma (78%), carcinosarcoma (12%), and giant-cell and/or spindle-cell carcinoma (10%). Blood vessel invasion (BVI) was present in 90% of cases. Morphology and immunohistochemistry were indicative of an adenocarcinoma, squamous, and adenosquamous origin in 41.5%, 17% and 11.5%, respectively, 30% remained not-otherwise-specified. KRAS, PIK3CA, EGFR, and MET mutations were found in 31%, 8%, 3%, and 3%, respectively. No tumors had HER2 or BRAF mutations, or ALK rearrangement, whereas 34% had a c-MET positive score. Five-year overall survival (OS) was 29% for the whole population. At multivariate analysis, tumor size <50mm (HR=1.96 [1.04-3.73], p=0.011), no lymph-node metastasis (HR=3.25 [1.68-6.31], p<0.0001), no parietal pleural invasion (HR=1.16 [1.06-1.28], p=0.002), no BVI (HR=1.22 [1.06-1.40], p=0.005), and no squamous component (HR=3.17 [1.48-6.79], p=0.01) were associated with longer OS. Biomarkers did not influence OS. CONCLUSION Dedifferentiation in NSCLC could lead to SC and an epithelial subtype component could influence outcome. BVI was present in almost all SCs and was an independent factor of poor prognosis.
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Affiliation(s)
- Thibault Vieira
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service de Pneumologie, F-75970 Paris, France
| | - Martine Antoine
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service d'Anatomie pathologique, F-75970 Paris, France
| | - Anne-Marie Ruppert
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service de Pneumologie, F-75970 Paris, France
| | - Vincent Fallet
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | - Michael Duruisseaux
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | | | - Virginie Poulot
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Plateforme de Génomique des Tumeurs Solides, F-75970 Paris, France
| | - Nathalie Rabbe
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | - Laurene Sclick
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | - Michele Beau-Faller
- Hôpital de Hautepierre, Laboratoire de Biochimie et de biologie moléculaire, F-67098 Strasbourg, France
| | - Roger Lacave
- AP-HP, Hôpital Tenon, Plateforme de Génomique des Tumeurs Solides, F-75970 Paris, France
| | - Armelle Lavole
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | - Jacques Cadranel
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service de Pneumologie, F-75970 Paris, France
| | - Marie Wislez
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service de Pneumologie, F-75970 Paris, France.
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