Abstract
ObjectiveLittle is known about prognostic factors for lung squamous cell carcinoma (SCC). We aimed to explore radiologic and clinical factors affecting prognosis and to compare the prognosis of both central and peripheral lung SCCs.Materials and methodsRadiologic, clinical, and pathologic profiles of surgically confirmed SCCs from 382 patients were retrospectively reviewed. Tumor location, enhancement, necrosis, the presence of obstructive pneumonitis/atelectasis and underlying lung disease were evaluated on chest CT examination. Age, pulmonary function, tumor marker, and cancer stage were also assessed. Univariate and multivariate Cox regression analyses were performed to identify any correlation to overall survival (OS) and disease-free survival (DFS). Hazard rate estimation and competing risk analysis were done to evaluate recurrence pattern.ResultsThe median follow-up period was 56.2 months. Tumors were located centrally in 230 patients (60.2%) and peripherally in 152 patients (39.8%). Age (p = 0.002, hazard ratio [HR] 1.03, 95% confidence interval [CI] = [1.01, 1.06]) and interstitial lung abnormalities (ILAs) (p<0.001, HR 5.41, 95% CI = [3.08, 9.52]) were associated with poor OS on multivariate analysis. ILAs also had a strong association to DFS (p<0.001, HR 4.25, 95% CI = [3.08, 9.52]). Central cancers had two peaks of local recurrence development at 15 and 60 months after surgery, and peripheral tumors showed rising curves for metastasis development at 60 months.ConclusionsCT-determined ILAs are a strong biomarker predicting poor outcome. Prognosis may not vary according to tumor location, but the two groups exhibited different recurrence patterns.
Highlights
Age (p = 0.002, hazard ratio [HR] 1.03, 95% confidence interval [CI] = [1.01, 1.06]) and interstitial lung abnormalities (ILAs) (p
ILAs had a strong association to disease-free survival (DFS) (p
Prognosis may not vary according to tumor location, but the two groups exhibited different recurrence patterns
Summary
While considerable progress has been made on classification and prognostication for lung adenocarcinomas (ADCs) by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society, comparatively little has been made with regard to lung squamous cell carcinomas (SCCs), which account for 25–30% of all lung cancers [1,2,3,4]. Recent advances in understanding molecular aberrations through comprehensive genotyping have led to the development of targeted agents for lung SCC [5,6]. Targeted agents such as fibroblast growth factor receptor (FGFR) inhibitors, phosphatidylinositol 3-kinase (PIK3K) inhibitors, insulin-like growth factor receptor 1 (IGF1R) monoclonal antibodies, and SOX2 have been investigated in clinical trials based on molecular genotyping. SCCs of the lung are categorized as central and peripheral cancers according to their location, and they manifest different clinicopathologic features. Central SCCs follow the dysplasia-carcinoma sequence, but the pathogenesis of peripheral cancers remains unclear [8,9]
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