Pulmonary Sarcomatoid Carcinoma: An Analysis of the National Cancer Data Base

Pulmonary sarcomatoid carcinoma (PSC) is a rare and aggressive form of lung cancer that has been little researched. We used the National Cancer Data Base to better understand PSC. A total of 7965 patients were identified with PSC, comprising 0.5% of all non-small-cell lung cancer (NSCLC) cases. Patients with PSC have aggressive clinical characteristics and inferior survival outcomes relative to other subtypes of NSCLC. Introduction: Pulmonary sarcomatoid carcinoma (PSC) is a grouping of 5 rare non-small-cell lung cancer (NSCLC) subtypes. We studied the clinical characteristics and outcomes of PSC utilizing the National Cancer Data Base (NCDB), an oncology outcomes database. Methods: The NCDB lung cancer database was queried from 1998 to 2011 for PSC using ICD-O-3 codes. Data were extracted for patient demographics, tumor pathology, treatment, and outcomes. Overall survival (OS) data were available for patients diagnosed from 1998 to 2006 and comorbidity data from 2003 to 2011. Univariate association with covariates between PSC and other forms of NSCLC was assessed by the chi-square test or ANOVA, as appropriate. Results: Of the 1,547,531 NSCLC patients in the NCDB from 1998 to 2011, 7965 were identified with PSC (0.5%). PSC patients had a median age of 70 years, 59% were men, and 89% were white. At presentation, 18% had American Joint Committee on Cancer stage I disease, 10% stage II, 24% stage III, and 48% stage IV. The median OS for stage I-II PSC was 16.9 months, 5.8 months for stage III, and 5.4 months for stage IV. There was a higher risk of death on multivariate analysis for PSC patients compared to other histologic subtypes of NSCLC in all patients (hazard ratio - 1.34 (95% confidence interval, 1.20-1.48) P <.001) and in propensity score-ematched subsets (hazard ratio 1.34; 95% confidence interval, 1.15-1.56; P <.001). Conclusion: PSC is a rare histologic subtype of NSCLC, accounting for 0.5% of all lung cancers. The disease of patients with PSC has aggressive clinical characteristics and an inferior survival outcome relative to other histologic subtypes of NSCLC. (C) 2016 Elsevier Inc. All rights reserved.