Abstract
Adenosquamous carcinoma (ASC) of the lung is an unusual histology type in non-small-cell lung cancers. Due to its rarity, the clinicopathological characteristics and survival outcomes of the lung ASC are incompletely understood. We used the Surveillance, Epidemiology, and End Results (SEER) database to enroll 203,208 eligible patients, including 4,245 ASC, 124,253 adenocarcinoma (ADC) and 74,710 squamous cell carcinoma (SCC) patients. To date, this is the largest cohort in a study for ASC of the lung. With regard to age, sex, race, year of diagnosis, tumor size and SEER stage, ASC was intermediate between ADC and SCC. However, compared with ADC and SCC patients, ASC patients presented with a higher tumor grade and lower prevalence of nodal metastasis. More ASC patients underwent surgery and a lower proportion underwent radiation treatment and chemotherapy. Kaplan-Meier analysis showed that ASC patients had a better prognosis than ADC and SCC patients, but stratified analysis showed that the prognosis of ASC patients was worse than that of ADC and SCC patients in surgery and non-surgery subgroup. Multivariate analysis further confirmed that the ASC histology type was a risk factor for poor prognosis with respect to ADC and SCC. Using the propensity score matching to 1:1 match ASC with ADC or SCC, we found that ASC patients had worse survival than ADC and SCC patients. Subgroup analysis further demonstrated that ASC was a more aggressive histology type with a worse prognosis. These results provided a deep understanding of ASC, which contributed to better clinical diagnosis and treatment.
Highlights
Adenosquamous carcinoma (ASC) of the lung is defined, according to World Health Organization (WHO), as a tumor having ≥ 10% components of both adenocarcinoma (ADC) and squamous cell carcinoma (SCC) [1, 2]
ASC patients carried a better prognosis than ADC and SCC patients, respectively (ASC vs. ADC, P < 0.001; ASC vs. SCC, P < 0.001)
The present study identified 4,245 ASC patients from the SEER database and this was the largest number of patients identified compared with other studies
Summary
Adenosquamous carcinoma (ASC) of the lung is defined, according to World Health Organization (WHO), as a tumor having ≥ 10% components of both adenocarcinoma (ADC) and squamous cell carcinoma (SCC) [1, 2]. Mordant et al [4] reported that ASC patients presented with similar features to those of ADC patients with regard to age, sex and smoking history, but had larger tumor size compared with ADC and SCC cases. Most studies have suggested that ASC patients have worse survival compared with ADC and SCC cases due to its more www.impactjournals.com/oncotarget aggressive biologic behaviors, but definitive conclusions on the prognosis have not been drawn. Filosso et al [6] reported that the 3- and 5-year survival of ASC patients after surgery were 25% and 15%, respectively, and overall survival was worse than that for ADC and SCC cases. Gawrychowski et al [7] showed that the overall survival at 5 and 10 years in ASC patients after surgery were 25.4% and 19.2%, respectively, and that ASC carried a worse prognosis compared with ADC and SSC. In 1999, WHO reclassified histology criteria for lung ASC [1], but most cases in these studies were obtained before 1999, which resulted in confounding of the clinicopathological characteristics and survival outcomes of ASC
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