The role of surgery in patients with metastatic pulmonary sarcomatoid carcinoma (PSC)：a SEER‑based study

Abstract

Abstract Objective In an effort to explore the prognostic role of surgery in patients with metastatic pulmonary sarcomatoid carcinoma, we performed a population-based study using the SEER data. Methods Patients with metastatic PSC were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2019. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated by univariate and multivariate analysis using the Cox regression analysis, α = 0.05. Survival curves were plotted by using the Kaplan-Meier method and survival curves were compared between groups with the log-rank test. Results A total of 931 patients were finally enrolled and 88 patients received surgery to the primary tumor site. Surgery was independently associated with improved outcome in patients with metastatic PSC. Median overall survival was 8.0 months (95% confidence interval [CI], 7.0 to 15.0) with surgery versus 3.0 months (95% CI, 3.0 to 4.0) without surgery (hazard ratio for death, 0. 576; 95% CI, 0.447 to 0.743; P<0.0001). The overall survival benefit was consistent regardless of the brain metastasis, radiotherapy and chemotherapy. Patients also benefited more from resection of at least one lobe and mediastinal lymph node dissection (HR = 0.484, 95%CI 0.289–0.812, P = 0.0035; HR = 0.441, 95%CI 0.267–0.728, P = 0.00064). Conclusions According to this study, surgery, especially lobectomy, bilobectomy or pneumonectomy with lymph node dissection, can prolong survival of patients with metastatic PSC. Treatment options for metastatic PSC should be based on multidisciplinary decision, and the possibility of surgery on primary tumor requires reasonable assessment.