Prognosis and distribution of lymph nodes metastases in resectable primary pulmonary lymphoepithelioma‐like carcinoma: A large cohort from a single center

Abstract

BackgroundPrimary pulmonary lymphoepithelioma‐like carcinoma is a rare subtype of lung cancer. Until now, the characteristics of lymph nodes metastases in resectable cases have not yet been reported.MethodsIn this study, a total of 87 consecutive patients with primary pulmonary lymphoepithelioma‐like carcinoma that received surgical treatment were investigated from October 1999 to August 2016. The clinical and radiological data and follow‐up information were extracted from hospital records in detail.ResultsIn a univariate analysis, those patients with an early pathological stage (I–II), low rate of lymph node metastases (<30%) and a low number of positive lymph nodes (<5) showed longer recurrence‐free survival and overall survival (all P < 0.05). However, the early pathological stage was identified as the only factor independently associated with recurrence‐free survival by multivariate analysis (P = 0.038). In a preoperative lymph nodes evaluation, the accuracy and specificity of computed tomography alone were 52.9% (46/87) and 88% (302/343), respectively, and 73.2% of these cases with incorrect nodal staging (30/41) were upstaged. Skipping metastases were more frequent in operated stage N2 cases (71.4%), whereas whether or not those patients showed skipping metastasis did not affect their recurrence‐free survival or overall survival (P > 0.05). The highest metastasis frequencies for specific lobes with primary lymphoepithelioma‐like carcinoma are as follows: #5 left upper lobe (21.4%); #7 left lower lobe (40.7%); #2R (28.6%) and/or #4R (14.3%) right upper lobe; #7 (42.9%) right lower lobe; #7 (28%) and/or superior mediastinal nodes (36%) right middle lobe.ConclusionBased on accurate staging and uncertain survival benefit, complete mediastinal lymph nodes dissection is still required for curative resection.

The clinicopathological features and prognosis of primary pulmonary lymphoepithelioma-like carcinoma: A systematic review and meta-analysis

“…Except for that, several distinct morphologic characteristics were observed in PPLELC including spread through alveolar spaces, lepidic spreading pattern, focal keratinization and granulomatous inflammation [37]. In previous studies, PPLELC primarily occurred in young individuals and non-smokers without sexual predilection [10,32,38,39]. The proportions reported by Qin et al [38] were 71.8% and 72.9%, respectively.…”

“…In our meta-analysis, male patients were prone to have a superior DFS. This may result from the relatively low proportion of male in the included studies [10,12,19,32], and female were considered to be predominated in PPLELC [35,36].…”

“…A large part of PPLELC patients were diagnosed at early stage, therefore they were reported to confer a superior prognosis compared with other histologic types of NSCLC [7,[9][10][11][12][13][14][15][16], with approximately 107 months vs 13 months (median overall survival), respectively [7,11]. However, the poor outcomes were found in advanced PPLELC patients at 24 months of median survival roughly [17].…”

Correlation and prognostic significance of PD-L1 and P53 expression in resected primary pulmonary lymphoepithelioma-like carcinoma

“…In limited literature reports, patients with primary pulmonary LELC survive longer than patients with other lung cancer subtypes (1)(2)(3). However, almost thirty-one percent of early stage patients experienced recurrence within five years after multimodality treatment, and nearly thirty-two percent of all patients with lung LELC presented with advanced disease at initial visits (1,(3)(4)(5). Thus, discovery of new therapeutic targets is needed to improve survival and quality of life further for recurrent or metastatic patients.…”

Clinicopathological Characteristics and Prognosis of Nasopharyngeal Lymphoepithelial Carcinoma: A Population-Based Retrospective Study

“…Moreover, intense lymphoplasmacytic cell infiltration in which the cellular borders are indistinct is observed, and the tumor cells often have a syncytial pattern. The tumor cell nuclei are round, oval, or elongated, with mild irregular nuclear borders, delicate chromatin, and 1 or 2 distinct eosinophilic nucleoli [ 8 ]. The incidence and prevalence of NLEC are low.…”