Pleomorphic Carcinoma of the Lung: Relationship Between CT Findings and Prognosis

The objective of our study was to assess the radiologic and clinical findings of pleomorphic carcinoma (PC) of the lung and to evaluate whether there are any characteristic features that can be used to predict prognosis.

Forty-four consecutive patients whose diagnosis of PC was histologically confirmed through resection of the lung tumor were included in this study. The clinical and CT findings of these patients were retrospectively reviewed. Two thoracic radiologists evaluated the CT findings including the size, location, internal characteristics, and margin characteristics of the tumors and the presence of chest wall invasion, mediastinal invasion, and surrounding lung abnormalities. A multivariate analysis by the Cox proportional hazards regression model was used to identify variables that can be used to predict overall survival and disease-free survival.

In the patients with PC, a central low-attenuation area or cavity (40/44, 91%), chest wall invasion (19/44, 43%), and pulmonary emphysema (30/44, 68%) were frequently observed on CT. On multivariate analysis, a massive central low-attenuation area or cavity (> 25% of the lesion) on CT indicating necrosis was the only significant independent factor for overall survival and disease-free survival (p < 0.05). Clinical findings, the presence of lymph node metastasis at surgery, and postoperative pathologic stage were not significant predictors of overall survival and disease-free survival.

A massive central low-attenuation area or cavity on CT was the only predictor of overall survival and disease-free survival in patients with lung PC.