1 Citation (Scopus)

Abstract

Objectives: Pulmonary pleomorphic carcinoma represents an understudied, rare, and aggressive histologic subtype of non–small cell lung cancer. Better understanding of rare disease subtypes allows for improved individualization of patient care. This study aimed to evaluate current trends in treatment and survival of pleomorphic carcinoma. Methods: The National Cancer Database was used to identify patients with staged, pleomorphic carcinoma and adenocarcinoma between 2004 and 2015. Patient characteristics and treatments were compared using χ2 tests. Cox proportional hazard models examined survival by stage after controlling for confounders. Propensity score matched Kaplan-Meier curves estimated survivor functions stratified by stage. Differences in survival following treatment for stage I pleomorphic carcinoma with surgery alone versus surgery plus chemotherapy were compared with Cox proportional hazard models and Kaplan-Meier survival curves. Results: One thousand four hundred eight patients with pleomorphic carcinoma and 607,561 patients with adenocarcinoma were identified. Pleomorphic carcinoma accounted for 0.1% of all non–small cell lung cancers. Pleomorphic disease had poorer overall 5-year survival compared with adenocarcinoma for stages I through IV (49.4% vs 59.1%, 34.5% vs 43.8%, 16.9% vs 28.4%, and 5.7% vs 7.8%, respectively; P <.0047 for all). Perioperative chemotherapy was used more frequently for pleomorphic disease (17.5% vs 6.1%; P <.001). For stage I pleomorphic cancer, treatment with surgery alone (n = 253) and surgery with chemotherapy (n = 57) had overall 5-year survival rates of 55.2% and 53.7%, respectively, and were not significantly different (P =.2868). Conclusions: Pulmonary pleomorphic carcinoma is rare and aggressive, with worse survival when compared with adenocarcinoma. Perioperative chemotherapy has not demonstrated significant survival benefits in stage I pleomorphic cancer.

Original languageEnglish (US)
Pages (from-to)581-591.e11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume158
Issue number2
DOIs
StatePublished - Aug 1 2019

Fingerprint

Lung Neoplasms
Carcinoma
Drug Therapy
Survival
Adenocarcinoma
Proportional Hazards Models
Non-Small Cell Lung Carcinoma
Neoplasms
Lung
Propensity Score
Kaplan-Meier Estimate
Therapeutics
Rare Diseases
Survivors
Patient Care
Survival Rate
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{6ef2558ac71949c3a676e759db8699ab,
title = "Perioperative chemotherapy is not associated with improved survival in stage I pleomorphic lung cancer",
abstract = "Objectives: Pulmonary pleomorphic carcinoma represents an understudied, rare, and aggressive histologic subtype of non–small cell lung cancer. Better understanding of rare disease subtypes allows for improved individualization of patient care. This study aimed to evaluate current trends in treatment and survival of pleomorphic carcinoma. Methods: The National Cancer Database was used to identify patients with staged, pleomorphic carcinoma and adenocarcinoma between 2004 and 2015. Patient characteristics and treatments were compared using χ2 tests. Cox proportional hazard models examined survival by stage after controlling for confounders. Propensity score matched Kaplan-Meier curves estimated survivor functions stratified by stage. Differences in survival following treatment for stage I pleomorphic carcinoma with surgery alone versus surgery plus chemotherapy were compared with Cox proportional hazard models and Kaplan-Meier survival curves. Results: One thousand four hundred eight patients with pleomorphic carcinoma and 607,561 patients with adenocarcinoma were identified. Pleomorphic carcinoma accounted for 0.1{\%} of all non–small cell lung cancers. Pleomorphic disease had poorer overall 5-year survival compared with adenocarcinoma for stages I through IV (49.4{\%} vs 59.1{\%}, 34.5{\%} vs 43.8{\%}, 16.9{\%} vs 28.4{\%}, and 5.7{\%} vs 7.8{\%}, respectively; P <.0047 for all). Perioperative chemotherapy was used more frequently for pleomorphic disease (17.5{\%} vs 6.1{\%}; P <.001). For stage I pleomorphic cancer, treatment with surgery alone (n = 253) and surgery with chemotherapy (n = 57) had overall 5-year survival rates of 55.2{\%} and 53.7{\%}, respectively, and were not significantly different (P =.2868). Conclusions: Pulmonary pleomorphic carcinoma is rare and aggressive, with worse survival when compared with adenocarcinoma. Perioperative chemotherapy has not demonstrated significant survival benefits in stage I pleomorphic cancer.",
author = "Hendriksen, {Brandon S.} and Hollenbeak, {Christopher S.} and Reed, {Michael F.} and Taylor, {Matthew D.}",
year = "2019",
month = "8",
day = "1",
doi = "10.1016/j.jtcvs.2019.04.005",
language = "English (US)",
volume = "158",
pages = "581--591.e11",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Perioperative chemotherapy is not associated with improved survival in stage I pleomorphic lung cancer

AU - Hendriksen, Brandon S.

AU - Hollenbeak, Christopher S.

AU - Reed, Michael F.

AU - Taylor, Matthew D.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objectives: Pulmonary pleomorphic carcinoma represents an understudied, rare, and aggressive histologic subtype of non–small cell lung cancer. Better understanding of rare disease subtypes allows for improved individualization of patient care. This study aimed to evaluate current trends in treatment and survival of pleomorphic carcinoma. Methods: The National Cancer Database was used to identify patients with staged, pleomorphic carcinoma and adenocarcinoma between 2004 and 2015. Patient characteristics and treatments were compared using χ2 tests. Cox proportional hazard models examined survival by stage after controlling for confounders. Propensity score matched Kaplan-Meier curves estimated survivor functions stratified by stage. Differences in survival following treatment for stage I pleomorphic carcinoma with surgery alone versus surgery plus chemotherapy were compared with Cox proportional hazard models and Kaplan-Meier survival curves. Results: One thousand four hundred eight patients with pleomorphic carcinoma and 607,561 patients with adenocarcinoma were identified. Pleomorphic carcinoma accounted for 0.1% of all non–small cell lung cancers. Pleomorphic disease had poorer overall 5-year survival compared with adenocarcinoma for stages I through IV (49.4% vs 59.1%, 34.5% vs 43.8%, 16.9% vs 28.4%, and 5.7% vs 7.8%, respectively; P <.0047 for all). Perioperative chemotherapy was used more frequently for pleomorphic disease (17.5% vs 6.1%; P <.001). For stage I pleomorphic cancer, treatment with surgery alone (n = 253) and surgery with chemotherapy (n = 57) had overall 5-year survival rates of 55.2% and 53.7%, respectively, and were not significantly different (P =.2868). Conclusions: Pulmonary pleomorphic carcinoma is rare and aggressive, with worse survival when compared with adenocarcinoma. Perioperative chemotherapy has not demonstrated significant survival benefits in stage I pleomorphic cancer.

AB - Objectives: Pulmonary pleomorphic carcinoma represents an understudied, rare, and aggressive histologic subtype of non–small cell lung cancer. Better understanding of rare disease subtypes allows for improved individualization of patient care. This study aimed to evaluate current trends in treatment and survival of pleomorphic carcinoma. Methods: The National Cancer Database was used to identify patients with staged, pleomorphic carcinoma and adenocarcinoma between 2004 and 2015. Patient characteristics and treatments were compared using χ2 tests. Cox proportional hazard models examined survival by stage after controlling for confounders. Propensity score matched Kaplan-Meier curves estimated survivor functions stratified by stage. Differences in survival following treatment for stage I pleomorphic carcinoma with surgery alone versus surgery plus chemotherapy were compared with Cox proportional hazard models and Kaplan-Meier survival curves. Results: One thousand four hundred eight patients with pleomorphic carcinoma and 607,561 patients with adenocarcinoma were identified. Pleomorphic carcinoma accounted for 0.1% of all non–small cell lung cancers. Pleomorphic disease had poorer overall 5-year survival compared with adenocarcinoma for stages I through IV (49.4% vs 59.1%, 34.5% vs 43.8%, 16.9% vs 28.4%, and 5.7% vs 7.8%, respectively; P <.0047 for all). Perioperative chemotherapy was used more frequently for pleomorphic disease (17.5% vs 6.1%; P <.001). For stage I pleomorphic cancer, treatment with surgery alone (n = 253) and surgery with chemotherapy (n = 57) had overall 5-year survival rates of 55.2% and 53.7%, respectively, and were not significantly different (P =.2868). Conclusions: Pulmonary pleomorphic carcinoma is rare and aggressive, with worse survival when compared with adenocarcinoma. Perioperative chemotherapy has not demonstrated significant survival benefits in stage I pleomorphic cancer.

UR - http://www.scopus.com/inward/record.url?scp=85065799673&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065799673&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.04.005

DO - 10.1016/j.jtcvs.2019.04.005

M3 - Article

C2 - 31122617

AN - SCOPUS:85065799673

VL - 158

SP - 581-591.e11

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 2

ER -