Advanced Pneumonic-type Lung Carcinoma: A Retrospective Study of Clinical-radiological-pathological Characteristics with Survival Analysis in A Single Chinese Hospital.
10.3779/j.issn.1009-3419.2019.06.01
- Author:
Yongjian LIU
1
;
Ji LI
2
;
Shibo WANG
3
;
Minjiang CHEN
1
;
Jing ZHAO
1
;
Delina JIANG
1
;
Wei ZHONG
1
;
Yan XU
1
;
Mengzhao WANG
1
Author Information
1. Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
2. Department of Pathology, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
3. Department of Respiratory and Critical Care Medicine, Weifang Respiratory Disease Hospital & Weifang No.2 People's Hospital, Weifang 261042, China.
- Publication Type:Journal Article
- Keywords:
Invasive mucinous adenocarcinoma;
Lung neoplasms;
Pneumonic-type lung carcinoma
- MeSH:
Aged;
Anaplastic Lymphoma Kinase;
genetics;
metabolism;
Antineoplastic Agents;
therapeutic use;
Carcinoma;
diagnostic imaging;
drug therapy;
genetics;
pathology;
ErbB Receptors;
genetics;
metabolism;
Female;
Gene Rearrangement;
Humans;
Lung Neoplasms;
diagnostic imaging;
drug therapy;
genetics;
pathology;
Male;
Middle Aged;
Mutation;
Neoplasm Staging;
Retrospective Studies;
Survival Analysis;
Tomography, X-Ray Computed
- From:
Chinese Journal of Lung Cancer
2019;22(6):329-335
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND:Pneumonic-type lung carcinoma is a special type of lung cancer both clinically and radiologically. Here we present our experience on pneumonic-type lung carcinoma in an attempt to investigate the clinical, radiological and pathological features, diagnostic procedures, treatment, and prognosis of this type of tumor.
METHODS:Pathologically confirmed lung cancer with a chest CT characterized by ground glass opacity or consolidation was defined as pneumonic-type lung carcinoma. Cases with advanced pneumonic-type lung carcinoma admitted to Peking Union Medical College Hospital (PUMCH) from January 1, 2013 to August 30, 2018 were enrolled. Retrospective analysis of clinical data and survival follow-up of these patients was conducted.
RESULTS:A total of 46 cases were enrolled, all of which were adenocarcinoma. Cough (41/46, 89.1%) and expectoration (35/46, 76.1%) were the most prominent symptoms. The most frequent chest CT findings were ground glass attenuation (87.0%), patchy consolidation (84.8%), and multiple ground-glass nodules (84.8%). Multiple cystic changes (40%) and cavitation (13%) were also quite frequent. Ipsilateral and contralateral intrapulmonary metastasis were noted in 95.3% and 84.8% of cases respectively. The median duration from symptom onset to diagnosis was 214 days (95%CI: 129-298). Both surgical lung biopsy and CT-guided percutaneous lung biopsy had a diagnostic yield of 100%. Transbronchial lung biopsy (TBLB) combined with bronchoalveolar lavage (BAL) had a diagnostic yield of 80.9% (17/21). Sputum cytology had a diagnostic yield of 45% (9/20). Twenty-six cases were invasive mucinous adenocarcinoma (26/46, 56.5%) and the remainder were unable to identify pathological subtypes due to lack of adequate biopsy sample size. EGFR mutation was detected in 15.8% (6/38) of patients and ALK rearrangement was detected in 3.0% (1/33) of patients. The median overall survival for these patients was 522 d (95%CI: 424-619). In patients without EGFR mutation or ALK rearrangement, chemotherapy significantly improved survival (HR=0.155, P=0.002,2). The median overall survival was 547 d (95%CI: 492-602 d) with chemotherapy and 331 d (95%CI: 22-919) without chemotherapy.
CONCLUSIONS:Diagnosis of pneumonic-type carcinoma is usually delayed due to clinical and radiological features mimicking pulmonary infection. TBLB combined with BAL has a quite high diagnostic yield. The most frequent histological type is invasive mucinous adenocarcinoma. The incidence of EGFR mutation or ALK rearrangement is low in pneumonic-type carcinoma. For patients without cancer driver genes, chemotherapy is recommended to improve overall survival.
