Expression of m6A-related factors in pulmonary sarcomatoid carcinoma

Pulmonary sarcomatoid carcinoma (PSC), a rare aggressive non-small cell lung carcinoma (NSCLC), arises from epithelioid-to-sarcomatoid transformation via epithelial-mesenchymal transition (EMT). This study aimed to investigate the expression levels of m6A-related factors in the process of sarcomatoid transformation of lung cancer, and summarize the clinicopathological features of PSC. Ten PSC patients (2018-2022) from Guilin Medical College Affiliated Hospital were retrospectively analyzed. Clinical and pathological features, including symptoms, imaging, histomorphology, and marker expression, were analyzed. The cohort included eight males and two females (median age 55.5 years; age range 48-72 years), with six patients having a smoking history. Tumors were predominantly located in the right upper lobe, with a median size of 3 cm (range 2.1-5 cm), and 50 % were at T2 stage. Immunohistochemistry revealed downregulated cytokeratin (CK) and upregulated Vimentin in sarcomatoid area (p < 0.001). Among m6A-related factors, Writers (methyltransferase-like 3 [METTL3], METTL16, Wilms' tumor 1-associating protein [WTAP]), Erasers (fat mass and obesity-associated protein [FTO], alkB homolog 5 [ALKBH5]), and Readers (YTH domain-containing 1 [YTHDC1], YTHDC2, YTH N6-methyladenosine RNA binding protein 1 [YTHDF1]) showed significant downregulation in sarcomatoid versus carcinomatoid components (p < 0.05), whereas methyltransferase-like 14 (METTL14), YTHDF2, and YTHDF3 showed no significant differences (p > 0.05). PSC typically affects middle-aged/elderly male smokers with aggressive progression. m6A dysregulation suggests EMT involvement, providing diagnostic/therapeutic targets.