title: Pathologic Findings and Long-Term Results After Surgical Treatment for Pulmonary Sarcomatoid Tumors: A Multicenter Analysis.
abstract: BACKGROUND
  Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small cell lung cancer (NSCLC). The aim of this study was to clarify the pathologic characteristics and long-term survival after surgical treatment in patients with PSC.
  
  
  METHODS
  From January 2003 to December 2013, we retrospectively reviewed the clinical findings, surgical notes, and pathologic and follow-up data from 148 consecutive patients who underwent curative resection for PSC in 5 institutions. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used.
  
  
  RESULTS
  Mean age and male to female ratio were 66.6 ± 9.9 years and 120:28, respectively. Surgical resection (pneumonectomy in 8 patients, bilobectomy in 132 patients, and sublobar resection in 8 patients) was complete in 142 cases (96%). At pathologic evaluation, 36 patients (24%) had stage I, 69 patients (47%) had stage II, 33 patients (22%) had stage III, and 10 patients (7%) had stage IV disease. A "biphasic tumor" (PSC with an NSCLC component) was observed in 77 patients (52%). We detected a high rate of vascular emboli in the surgical specimens (overall, 68%; 57% in pathologic stage I tumors), whereas lymphatic emboli were found in 30% of cases (5% of pathologic stage I tumors). Overall median and 5-year long-term survival (LTS) was 19 months and 12.6% (LTS, 16.3% in pathologic stage I), respectively. Distant recurrences frequently occurred after surgical treatment (81%), even in pathologic stage I tumors that underwent R0 resection (62%). Multivariable survival analysis identified R+ resection (hazard ratio [HR],12.3; 95% confidence interval [CI], 3.67-41.28; p < 0.0001), advanced pathologic stage (HR, 5.75; 95% CI, 2.55-12.98; p < 0.0001), and the presence of vascular emboli (HR, 1.67; 95% CI, 1.05-2.67; p = 0.0327) as independent negative prognostic factors.
  
  
  CONCLUSIONS
  PSCs have very aggressive behavior and high metastatic potential even in early stages. R+ resection, pathologic TNM status, and the presence of vascular emboli are independent prognostic factors.
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy. Electronic address: filippo_lococo@yahoo.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Rapicetta
authors.affiliation: Unit of Thoracic Surgery, San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
authors.affiliation: Unit of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Stefani
authors.affiliation: Department of General Thoracic Surgery, Catholic University, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.affiliation: Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Leuzzi
authors.affiliation: Unit of Pathology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Department of General Thoracic Surgery, Catholic University, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Petracca Ciavarella
authors.affiliation: Unit of Thoracic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Uliano
authors.initials: U
authors.lastname: Morandi
authors.affiliation: Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Facciolo
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Ricchetti
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cesario
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Paci
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D004617:Embolism / Q000209:etiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012509:Sarcoma / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate