Resected Pure Small Cell Lung Carcinomas and Combined Small Cell Lung Carcinomas: Histopathology Features, Imaging Features, and Prognoses.
AJR Am J Roentgenol. 2019 Apr;212(4):773-781. doi: 10.2214/AJR.18.20519. Epub 2019 Jan 23.
Woo JH1, Kim MY1, Lee KS1, Jeong DY1, Chung MJ1, Han J2, Shim YM3.
OBJECTIVE: The objective of our study was to investigate histopathology features, imaging features, and prognoses of surgically resected pure small cell lung carcinomas (SCLCs) and combined SCLCs.
MATERIALS AND METHODS: Forty-one patients with a pure SCLC or a combined SCLC underwent preoperative chest CT and 18F-FDG PET/CT and subsequent surgical resection. The clinicopathologic findings were noted by reviewing the electronic medical records. The imaging features of individual tumors were analyzed on chest CT and PET/CT scans. Each tumor was classified as being located centrally (at or in the segmental bronchus or proximal to the segmental bronchus) or peripherally (distal to the segmental bronchus). The maximum standardized uptake value (SUVmax) of each tumor was measured at PET. The 7th edition of the TNM staging system was adopted for staging.
RESULTS: The study group was composed of 34 men and seven women with a mean age of 62.0 ± 10.2 (SD) years. Sixteen of 41 (39%) patients had pure SCLC, and the remaining patients had combined SCLC. The most common combined SCLC histologic subgroup was combined SCLC and large cell neuroendocrine carcinoma in 17 (41%) patients. The mean SUVmax of pure SCLCs was 5.6 ± 2.2 and was significantly lower than that of combined SCLCs (p < 0.01). Thirty-one patients (76%) had a peripheral tumor, and 10 (24%) had a central tumor. The overall survival (OS) of the 10 patients with a central tumor was 44.6 months, significantly shorter than the OS of the 31 patients with a peripheral tumor (179.2 months) (p = 0.017). The OS of 21 patients with stage I disease was significantly longer than the OS of patients with higher-stage cancer (p = 0.004).
CONCLUSION: In our study group of patients with surgically resected SCLC, patients with a peripheral tumor (including a purely endobronchial tumor) or stage I disease showed a better prognosis than those with a central tumor or higher-stage disease.