Abstract
Purpose: To assess clinical data and preoperative CT findings associated with prognosis in sarcomatoid-NSCLC (s-NSCLC) patients.
Material and Methods: In this retrospective study, s-NSCLC patients who underwent contrast enhanced thoracic CT or PET/CT from January 2013 to June 2023 at three centers were enrolled. Clinicoradiological data, including sex, age, smoking history, TNM classification, tumor size, tumor location, calcification, vacuole/cavity, pleural invasion, low-attenuation area (LAA) ratio, hydrothorax, peritumoral ground-glass opacity (GGO), nodule or atelectasis and SUVmax were calculated. Clinicoradiological findings associated with overall survival were evaluated by a multivariate Cox regression model.
Results: A total of 135 with s-NSCLC were included. The s-NSCLC patients were more likely to be elderly male smokers. The mean age and tumor size at diagnosis was 62 years and 5.8 cm. The median survival time of patients with s-NSCLC was 9 (95% CI: 7, 11) months. The 1-, 3- and 5-year overall survival (OS) rates of the s-NSCLC patients were 28.9%, 11.9% and 5.9%, respectively. s-NSCLC is often peripherally locate (98/135, 70.4%). Calcification (19/135, 14.1%) and Vacuole/cavity (22/135, 16.2%) were rare in s-NSCLC lesions. Pleural invasion and hydrothorax was present in 75/135 (55.6%) and 36/135 (26.7%) of s-NSCLC patients. The s-NSCLC lesions usually present with LAA (87/135, 80.6%), the median LAA ratio was 30.8% (IQR: 10.6%, 50.7%). The SUVmax of s-NSCLC lesions were 20.2 (IQR: 14.0, 23.9). Surgical treatment [hazard ratio (HR) = 0.518] was associated with decreased mortality, while peritumoral GGO, nodule or atelectasis (HR = 1.995) were associated with increased mortality.
Conclusions: Peritumoral GGO, nodule or atelectasis is an independent risk indicator associated with poor prognosis, while complete surgical resection is essential for improving the prognosis in s-NSCLC patients.