J Huazhong Univ Sci Technol [Med Sci] 35(3):350-355,2015 DOI 10.1007/s11596-015-1436-z J Huazhong Univ Sci Technol[Med Sci] 35(3):2015

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Clinicopathological Characteristics and Prognosis of Patients with Adenosquamous Lung Carcinoma Ye GUO (郭 晔)1, Lin JIA (贾 琳)1, Guo-guang SHAO (邵国光)2, Hong-wei SUN (孙宏伟)1, Xing-xing WANG (王星星)1, Guan-jun WANG (王冠军)1, Ke-wei MA (马克威)1# 1 Department of Oncology, 2Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun 130021, China © Huazhong University of Science and Technology and Springer-Verlag Berlin Heidelberg 2015

Summary: This study was aimed to characterize clinicopathological features and prognosis of patients with adenosquamous lung carcinoma (ASC). Among the 2531 patients with lung cancer who underwent surgery between January 2000 and June 2012 in our hospital, 59 were histologically diagnosed as having ASC. The clinicopathological features and follow-up data of ASC patients were collected and analyzed statistically. Superior lobectomy was accomplished in 40 patients, middle and inferior lobectomy in 3, lobectomy plus partial resection of contralateral lung in 5, partial lung resection in 4, and pneumonectomy in 7. Moreover, 22 cases were found to be adenocarcinoma-predominant, and 18 to be squamous cell carcinoma-predominant. The median survival time was 13.6 months, and the 1-, 3-, and 5-year survival rates were 59.9%, 36.4% and 31.2%, respectively. Of the 52 cases with tissue specimens available, 11 had an EGFR mutation (21.2%) and 2 had a KRAS mutation (3.8%). Multivariate analysis showed that histology subtype, pleural invasion, TNM stage, and postoperative treatment were all independent prognostic factors. The data from the current study demonstrated that SCC-predominant histology represents a better prognosis of ASC. Histology subtype, pleural invasion, TNM stage, and postoperative treatment are independent prognostic factors for ASC and adjuvant therapy may help control the disease. Key words: lung adenosquamous carcinoma; histology; clinicopathological feature; prognosis; EGFR and KRAS mutation

Lung cancer is a major health problem worldwide and contributes to 1.38 million cancer-related deaths, accounting for 18.2% of the total worldwide cancer deaths in 2008[1]. Primary lung cancer is usually classified into two types, small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). The latter can further be divided into three main subtypes, including squamous cell carcinoma (SCC), adenocarcinoma (AC), and large cell carcinoma. Additionally, there are other rare subtypes of NSCLC, such as sarcomatoid carcinoma, adenosquamous carcinoma (ASC), carcinoid tumor, salivary gland-like carcinoma, and miscellaneous tumor[2]. ASC is pathologically characterized by having at least 10% SCC and AC cells in total volume. It accounts for 0.3% to 5% of all lung cancer cases[2–5]. Clinically, ASC is characterized by rapid growth, high invasiveness, early metastasis[6, 7], and a very poor prognosis[3, 5–7]. However, due to its rarity, less attention is paid to ASC clinically[2]. Only several reports described the pathologic features of ASC decades ago[8–18]. Previously, SCLC was primarily treated with chemoradiation therapy and NSCLC with surgery. Currently, treatment regimens have greatly been improved, including target therapy, especially for NSCLC, in addition to novel chemotherapeutical drugs[18]. Thus, further investigation of ASC is warranted due to its unique combination pathology of SCC and AC[17, 19]. In this study, we investiYe GUO, E-mail: [email protected] # Corresponding author, E-mail: [email protected]

gated 59 histologically diagnosed ASC patients from a series of 2531 lung cancer patients to better understand the clinical features and prognosis of ASC and the optimal therapeutic strategies for ASC. 1 SUBJECTS AND METHODS 1.1 Study Population Between January 2000 and June 2012, among 2531 NSCLC patients who underwent surgical resection in the Department of Thoracic Surgery of the First Hospital of Jilin University, China, 59 were histologically diagnosed with ASC and enrolled in the study. This study was approved by our institutional review board, and informed consents were obtained from all the patients. 1.2 Pathologic Examination Tissue sections from 52 ASC cases were stained with hematoxylin and eosin and then independently reviewed and diagnosed by two pathologists. According to AC and SCC characteristics in each case, we subdivided them into the following subgroups (fig. 1): AC predominant group, in which the AC component was equal to or more than 60% of tumor cells[20]; SCC predominant group, in which the AC component was less than 50%; and equal AC and SCC group, in which the AC component was 50%–60%. Tumor differentiation was classified as well, moderate, and poor. Tumor stages were classified based on the tumor, node and metastasis (TNM) staging system according to the 7th edition of the TNM classification for lung cancer (AJCC, USA). In addition,

J Huazhong Univ Sci Technol[Med Sci] 35(3):2015

pleural invasion was defined as follows: P0, lack of pleural invasion beyond the elastic layer; P1, invasion beyond the elastic layer; P2, invasion to the surface of

351 the visceral pleura; and P3, invasion of the parietal pleura and/or chest wall[21].

Fig. 1 Histopathological features of ASC (HE staining, ×100) A: moderately differentiated ASC; B: poorly differentiated ASC; C: AC predominant ASC; D: SCC predominant ASC; E: ASC having equal proportion of AC and SCC

1.3 Detection of Gene Mutations Polymerase chain reaction (PCR) was performed to amplify epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene (KRAS) in 52 tissue specimens. DNAssitant software (DNA marker, Dalian, China) was used to confirm the mutated gene by combining with artificial proofreading after DNA sequencing. 1.4 Statistical Analysis All of the statistical analyses were performed using SPSS 16.0 (SPSS, USA). The χ2 test was used to compare study groups and P

Clinicopathological characteristics and prognosis of patients with adenosquamous lung carcinoma.

This study was aimed to characterize clinicopathological features and prognosis of patients with adenosquamous lung carcinoma (ASC). Among the 2531 pa...
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