Abstract
An uncommon form of non-small-cell lung cancer (NSCLC) with a poor
prognosis is pulmonary sarcomatoid carcinoma (PSC). Surgical resection
is currently the preferred treatment, but guidelines for adjuvant
chemotherapy haven’t yet been established, especially for the advanced
stage. The development of molecular subgroups in the field of tumors may
be advantageous to advanced PSC patients with the ongoing progress of
genomics and immunology. A 54-year-old man presented to Xishan People’s
Hospital of Wuxi City with recurrent intermittent dry cough with fever
for one month. Further examinations suggested the diagnosis of PSC
occupying almost the entire right interlobar fissure area combined with
malignant pleural effusion (stage IVa). Pathological examination
confirmed the diagnosis of PSC with ROS1 overexpressing via
genetic testing. However, after three cycles of chemo-,
antiangiogenetic- and immunochemical therapy, the lesion was localized,
and pleural effusion disappeared, the patient subsequently received an
operation which was performed as R0 resection. Unfortunately, the
patient became deteriorated quickly followed by extensive metastatic
nodules in the thoracic cavity. Although the patient continued to
receive chemo- and immunochemical- therapy, it did not limit the
progress of the tumor, leading to widespread metastasis, and eventually
died of multiple organ failure. For PSC patients with stage IVa, chemo-,
antiangiogenetic- and immunochemical- therapy performs well in clinical
efficacy, and comprehensive panel-based genetic testing may offer PSC
patients a somewhat better prognosis. However, blindly implementing
surgical treatment may bring harm to the patient and affect long-term
survival. It’s essential to know the surgical indications precisely by
NSCLC guidelines.
Keywords: Pulmonary sarcomatoid carcinoma; Non-small cell lung
cancer (NSCLC); Chemotherapy; Antiangiogenetic therapy; Genetic testing;
ROS1.