Ringed fluorodeoxyglucose uptake predicted poor prognosis after resection of pulmonary pleomorphic carcinoma

Abstract

Background Pulmonary pleomorphic carcinoma (PPC) is a relatively rare and poorly differentiated non-small cell carcinoma. This study aimed to investigate the clinicopathological features including programmed cell death ligand 1 (PD-L1) expression status in patients with PPC who underwent curative resection. Methods We retrospectively studied 29 consecutive patients who had undergone anatomical lung resections for PPC. Perioperative and pathological variables, including radiological findings, were investigated to define prognostic factors. Results Overall survival (OS) rates were 71.8% at 1 year and 60.0% at 5 years. Disease-free survival (DFS) rates were 54.8% at 1 year and 43.6% at 5 years. Univariate analysis revealed that ringed fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) (p = 0.003), a cavity in the tumor on CT (p = 0.004), and tumor size (> 40 mm) (p = 0.014) were poor prognostic factors for OS. Regarding DFS, ringed FDG uptake (p = 0.002), a cavity on CT (p < 0.001), tumor size (p = 0.007), and pleural invasion (p = 0.014) were poor prognostic factors. PD-L1 expression was not a prognostic factor. Conclusion This study showed for the first time that ringed FDG uptake on PET/CT is a poor prognostic factor of PPC. PD-L1 expression status was not related to the prognosis. Trial registration The study was approved by the Kobe City Medical Center General Hospital’s ethics board (No. 20112) on August 20, 2020.

18F-FDG PET/CT imaging in pulmonary sarcomatoid carcinoma

“…To the best of our knowledge, this is one of the 18 F-FDG PET/CT study with a larger PSC sample. We had some similar findings to previous investigations ( 4 , 8 , 11 , 12 ): PSCs occurred in old-aged individuals with significant male preponderance; Most patients had a smoking history; in 80% of cases the lesions were located in the upper lobe of the bilateral lung, especially in the peripheral lung; at diagnosis, most PSM presents as > 3cm mass; necrosis is frequent in lesions.…”

“…In our case, intrapulmonary metastasis is not uncommon, which may be related to tumor vascular invasion. The study of Shishido et al showed that more than half of the patients with pulmonary pleomorphic carcinoma had vascular invasion (12). The distant metastases of PSC were mainly in lymph nodes and bone.…”

“…At diagnosis, although PSC is often large when detected, metastasis mainly involves the ipsilateral hilar and mediastinal lymph node, adjacent pleural ( 4 , 12 ). Pleural invasion usually presents broad base infiltration, as shown in Figure 1 .…”

“…The study of Shishido et al. showed that more than half of the patients with pulmonary pleomorphic carcinoma had vascular invasion ( 12 ). The distant metastases of PSC were mainly in lymph nodes and bone.…”

“…Shishido Y et al. reported only 3 cases diagnosed with PSC preoperatively in a cohort of 29 patients who had undergone PET/CT scan ( 12 ). An early histopathologic analysis is essential to not delay PSC diagnosis.…”