Clinicopathological characteristics of surgically resected pulmonary pleomorphic carcinoma

Since few large-scale studies of patients with pleomorphic carcinoma have been documented, factors affecting survival after pulmonary resection for pleomorphic carcinoma, as well as its clinicopathological characteristics, are still unknown. For a better understanding of the patients undergoing resection of pulmonary pleomorphic carcinoma, we reviewed our experience with these patients.

Between 2002 and 2010, 26 patients with pulmonary pleomorphic carcinoma underwent macroscopically complete pulmonary resections. Various perioperative variables were investigated retrospectively to confirm a role for pulmonary resection and to analyse prognostic factors for overall survival and disease-free survival after lung resection.

Twenty-four patients (92%) were male. Twenty-one patients (81%) were smokers and all of them smoked more than 30 pack-years. In 25 patients (96%), the tumour was located peripherally. Twenty-three of these 25 patients revealed the tumour touching the visceral pleura widely in the preoperative chest computed tomography. In all 26 patients, the tumour was completely resected macroscopically; however, three patients (12%) had microscopically positive surgical margins. Among them, additional irradiation was conducted in two patients and additional surgical resection was performed in one patient. Combined resections were performed in 11 patients (42%), including chest wall resections in 7 patients. Overall survival rate after pulmonary resection was 48% at 5 years. Disease-free survival rate after pulmonary resection was 33% at 5 years. Patients with tumours invading the visceral pleural surface and microscopically positive surgical margin had significantly worse overall survivals (P = 0.048 and 0.037, respectively). However, there were no significant prognostic factors for disease-free survival.

Despite small number of cases, we found that pleural invasion suggested a worse prognosis for resection of pulmonary pleomorphic carcinoma. Surgical strategy might be constructed to achieve not only macroscopically, but also microscopically complete resection for such large tumours with aggressive nature and peripheral preference.