Preoperative systemic immune-inflammation index predicts survival and recurrence in patients with resected primary pulmonary sarcomatoid carcinoma.
Preoperative systemic immune-inflammation index predicts survival and recurrence in patients with resected primary pulmonary sarcomatoid carcinoma.
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DOI：
10.21037/tlcr-20-960
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发表时间：
2021-01
影响因子：
4
通讯作者：
He J
中科院分区：
文献类型：
--
作者：
Zeng Q;Li J;Sun N;Xue Q;Gao Y;Zhao J;Mao Y;Mu J;Wang D;Gao S;He J
肺肉瘤样癌是一种罕见的肺癌亚型。关于PSC的研究是有限的和有争议的，因此，我们分析了PSC的治疗和结果，利用一个相对较大的单机构数据库。从2003年1月至2018年12月，对在我们机构接受治疗的262例连续PSC患者进行了回顾性分析。分析其临床特征、治疗方法和结局。中位生存期（MST）为22.0个月，1年、3年和5年总生存率（OS）分别为59.9%、40.1%和36.1%。接受手术治疗的患者的预后明显好于接受非手术治疗的患者（MST，23.0 vs. 11.0个月，P=0.016）。手术后辅助治疗的使用显著延长了III期患者的生存期（MST，17.0 vs. 8.0个月，P=0.003），但在I期和II期患者中没有。多因素分析显示，全身炎症免疫指数（SII）>430.8、TNM分期和坏死是影响根治性切除PSC患者OS和无病生存期（DFS）的独立预后因素（P<0.05）。此外，SII和坏死是PSC根治性切除术后复发的独立危险因素（P<0.05）。PSC具有侵袭性，预后较差。对于可手术的病例，手术应该是主要的治疗方法，对于局部晚期疾病，建议进行辅助治疗。一种新型的潜在生物标志物SII是基于术前淋巴细胞、中性粒细胞和血小板计数的综合参数，可能有助于预后预测和识别复发高风险的切除后原发性硬化性肝癌患者。
Pulmonary sarcomatoid carcinoma (PSC) is a rare lung cancer subtype. Studies concerning PSC are limited and controversial; therefore, we analyzed the treatment and outcomes of PSC utilizing a relatively large single-institution database. From January 2003 to December 2018, 262 consecutive PSC patients treated at our institution were retrospectively reviewed. The clinical characteristics, treatments, and outcomes were analyzed. The median survival time (MST) was 22.0 months, with 1-, 3-, and 5-year overall survival (OS) rates of 59.9%, 40.1%, and 36.1%, respectively. Patients who underwent surgery had a significantly better prognosis than patients who received nonsurgical treatment (MST, 23.0 vs. 11.0 months, P=0.016). The use of surgery followed by adjuvant therapy significantly prolonged survival in stage III patients (MST, 17.0 vs. 8.0 months, P=0.003) but not in stage I and II patients. Multivariate analysis showed that a systemic inflammation-immune index (SII) value >430.8, TNM stage and necrosis were independent prognostic predictors of OS and disease-free survival (DFS) in radically resected PSC patients (P<0.05). In addition, SII and necrosis were independent risk factors for recurrence after the radical resection of PSC (P<0.05). PSC is aggressive and has a poor prognosis. Surgery should be the mainstay treatment for operable cases, and adjuvant therapy is recommended for locally advanced disease. A novel potential biomarker, SII, which is an integrated parameter based on preoperative lymphocyte, neutrophil, and platelet counts, may be useful for prognostic prediction and the identification of resected PSC patients at high risk for recurrence.