Adjuvant chemotherapy for pulmonary sarcomatoid carcinoma: A retrospective analysis of the National Cancer Database

Pulmonary sarcomatoid carcinoma (PSC) is a rarely occurring variant of non-small cell lung cancer with sarcoma-like features. Compared with traditional non-small cell lung cancer, PSC patients typically present later and have poorer prognoses, irrespective of stage. The standard of care is resection, but guidelines for the use of adjuvant chemotherapy have not been established. To advance the development of evidence-based management algorithms for PSC after resection, a statistical analysis on a nationwide representative sample of patients was performed. A retrospective cohort study was performed by querying the National Cancer Database for patients with a diagnosis of PSC between 2004 and 2015. Patients who received complete anatomical resection with or without adjuvant chemotherapy were included. Multivariable regression was used to detect factors associated with the receipt of adjuvant chemotherapy. Multivariable Cox regression of overall survival and Kaplan-Meier survival analysis on propensity-matched groups was conducted to study the association between adjuvant chemotherapy and prognosis. We included 1497 patients with PSC in the final analysis. Factors associated with receiving adjuvant chemotherapy were age, histology, and receipt of adjuvant radiation. The results of multivariable Cox analysis and Kaplan-Meier analysis on propensity matched groups yielded similar trends: adjuvant chemotherapy was associated with improved 5-year overall survival for stage II and III disease, but not for stage I disease. Multiple factors are associated with receipt of adjuvant chemotherapy for PSC, and this treatment appears to be associated with improved survival in stage II and stage III, but not stage I patients. Overview of study and findings. In this work, the National Cancer Database (NCDB) was probed for patients with a diagnosis of pulmonary sarcomatoid carcinoma diagnosed between 2004 and 2015 and who received R0 surgery. Patients who received adjuvant chemotherapy and who did not receive adjuvant chemotherapy were matched by propensity scores incorporating age, sex, race, tumor size, tumor histology, facility type, extent of resection, receipt of adjuvant radiation, and Charlson-Deyo Comorbidity scores. Kaplan-Meier analysis on the resulting groups showed that chemotherapy has no effect on survival in stage I disease, but improved overall survival in stage II and even further in stage III disease. On the basis of this analysis, adjuvant chemotherapy appea