Pulmonary Sarcomatoid Carcinoma: Updated Analysis on Prognostic Factors Influencing Diagnosis and Survival
Indian Journal of Surgery, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s12262-026-04657-0
- Dergi Adı: Indian Journal of Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
- Anahtar Kelimeler: Giant cell carcinoma, Spindle cell carcinoma, Positron emission tomography (PET), Pulmonary sarcomatoid carcinoma, Pleomorphic carcinoma, Carcinosarcoma, Pulmonary blastoma
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Pulmonary sarcomatoid carcinomas (PSCs) represent an uncommon and poorly differentiated subtype of non-small cell lung cancer with aggressive behavior and poor prognosis. Their diagnosis is challenging due to histological heterogeneity and nonspecific presentation, while treatment options are limited as most patients present with advanced disease. Conventional chemotherapy shows low efficacy, and the role of molecular and metabolic markers remains unclear, underscoring the need for better prognostic tools and individualized management. This study involved a retrospective evaluation of patients diagnosed with pulmonary sarcomatoid carcinoma (PSC) and treated at our center between January 2011 and December 2020. Clinical, pathological, and PET-CT metabolic parameters (SUVmax, SUVmean, MTV), pathological lymph node involvement, recurrence patterns, disease-free survival (DFS), and overall survival (OS) were retrospectively analyzed. Multivariable Cox regression analysis was performed to identify independent prognostic factors associated with survival. The study population consisted of 55 patients (80% male, median age 64 years). Median tumor size was 5.6 cm. Forty patients underwent surgical resection, while 15 were managed non-surgically. Pleomorphic carcinoma was identified as the most common subtype, followed by spindle cell and giant cell carcinoma. During a median follow-up of 24 months, recurrence occurred in 52.5% of surgically treated patients, predominantly as distant metastases (47.5%). Surgically treated patients demonstrated significantly longer overall survival compared with non-surgically treated patients (p = 0.010). Recurrence occurred in 52.5% of surgically treated patients, predominantly as distant metastasis. On PET-CT, median SUVmax, SUVmean, and MTV were 13.8, 5.5, and 71.8, respectively. PET-CT metabolic parameters (SUVmax, SUVmean, MTV) showed no statistically significant association with OS or DFS. Although PET-CT demonstrated high sensitivity for lymph node metastasis detection, its specificity was limited due to false-positive findings. In multivariable Cox regression analysis, pleural invasion remained independently associated with poorer OS. Pleural invasion and pathological N1 lymph node involvement were associated with poorer survival outcomes in PSC. PET-CT metabolic parameters (SUVmax, SUVmean, MTV) demonstrated limited prognostic value, whereas PET-CT retained an important role in diagnostic evaluation and disease staging. Larger multicenter prospective studies are needed to validate prognostic factors and optimize treatment strategies in PSC.