Sarcomatoid lung cancer (spindle/giant cells): an aggressive disease?

We investigated the clinical, surgical, and pathologic features of sarcomatoid lung carcinomas with spindle/giant cells, giving special attention to the prognostic behavior of these rare tumors.

Surgical specimens from 39 patients (29 men and 10 women; mean age, 61 years) were examined by means of light microscopy. Preoperative and postoperative data were collected, and survival was calculated by using the Kaplan-Meier method.

Nineteen patients were diagnosed with cancer preoperatively. Only one sarcomatoid tumor had been diagnosed. Presenting symptoms were noted in 85% of patients, and complete resection was achieved in 37 tumors. Postoperative pTNM staging: T2/T3/T4, 22/15/2; N0/N1/N2, 28/8/3; 15 stage IB, 14 stage IIB, 7 stage IIIA, 2 stage IIIB, and 1 stage IV. Histopathologic analysis revealed necrosis in 90% of the tumors (34 pleomorphic, 3 spindle cell, and 2 giant cell carcinomas). During follow-up (median, 24 months), 21 patients died of disease recurrence, and 3 died of postoperative complications. The 5-year survival rate (33%; median, 11 months) was negatively influenced by large tumors (7.5% survival for > or =7 cm vs 56% for <7 cm, P = .0026). The disease-free interval was significant for patients who relapsed (0% for disease-free interval <6 months vs 33% for disease-free interval > or =6 months, P = .0019).

A highly heterogeneous group, spindle/giant cell lung carcinomas tend to be symptomatic, peripheral, and necrotic. Preoperative diagnosis is difficult. Most patients in our study relapsed and died the first year after surgical intervention. Surgical intervention can permit long-term survival, but adjuvant therapy warrants consideration because of the aggressive nature of these tumors.