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    EP1.09 - Pathology (ID 199)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Pathology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.09-21 - Sarcomatoid Carcinoma of the Lung. Analysis of the Tumor Immune-Microenvironment and Survival of a Case Series (Now Available) (ID 2644)

      08:00 - 18:00  |  Author(s): Thomas Raptakis

      • Abstract
      • Slides

      Background

      Sarcomatoid carcinoma is a poorly differentiated non-small-cell lung carcinoma that comprises 3 subtypes i)the pleomorphic including different components such as squamous cell carcinoma, adenocarcinoma, or undifferentiated non-small-cell carcinoma and at least 10% spindle and/or giant cells; ii)the spindle cell consisting only of spindle cells and iii)the giant cell. The study aimed to assess the presence of immune cells in tumoral environment and the survival of patients (pt) with these tumors

      Method

      Formalin-fixed paraffin-embedded tissues of pt treated with surgery for sarcomatoid carcinoma from 2009-2014 were retrieved and centrally revised and restaged. PAS diastase staining and immunohistochemistry with CK7, p63 and vimentin were performed to identify epithelial and mesenchymal components. The presence of tertiary lymphoid structures, plasma cells and necrosis were assessed. Clinical data were collected from patients’ files regarding adjuvant treatment (chemotherapy, radiotherapy) and survival. Institutional Review Board, Ethical Approval and patient’s signed informed consent were obtained.

      Result

      Ten pt of median age 74 (59-80) years, were treated with pneumonectomy (1 pt) upper (4pt) or lower (5pt) lobectomy for pleomorphic (8pt) or giant cell (2pt) sarcomatoid carcinoma. Squamous or adenocarcinoma components were each present in 4 pt. Visceral pleural involvement was present in 5pt and parietal in 1 pt. TNM staging and the composition of tumor microenvironment are shown in Table 1. Tumor spread through airspace was present in 3 pt and lymphovascular invasion in 5 pt. At the time of the analysis, only 2 pt were alive, the median time to recurrence was 11.5 months and the median survival was 1.8 years

      Patient number

      Staging WHO 8TH Edition

      Plasma Cells

      Tertiary Lymphoid Structures

      Pattern of Necrosis

      1

      pT3N0 (IIB)

      Absent

      Focal Aggregates

      Diffuse

      2

      pT4N1 (IIIA)

      Small

      Primary Follicles

      Focal

      3

      pT2N1 (IIB)

      Absent

      Focal Aggregates

      Diffuse

      4

      pT2N0 (IIA)

      Small

      Primary Follicles

      Diffuse

      5

      pT2aN2 (IIIA)

      Absent

      Focal Aggregates

      Focal

      6

      pT1cN0 (IA3)

      Small

      Focal Aggregates

      Diffuse

      7

      pT2aN2 (IIIA)

      Absent

      Primary Follicles

      Focal

      8

      pT1cN0 (IA3)

      Absent

      Focal Aggregates

      Diffuse

      9

      pT1cN0 (IA3)

      Intermediate

      Primary Follicles

      Diffuse

      10

      pT4N0 (IIIA)

      Absent

      Focal Aggregates

      Diffuse

      Conclusion

      Sarcomatoid carcinoma represents a rare disease with an aggressive clinical course and a poor prognosis even in stage IA3 treated with combination therapies. The exact mechanisms whereby the formation of tertiary lymphoid structures occurs and their function remain elusive. Studying these changes could reveal new ways for modulating immune responses to prolong the survival of these pt.

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