The Clinical Characteristics And Prognosis Of Lymphoepithelioma-like Carcinoma

Background:Lymphoepithelioma-like carcinoma(LELC)is a malignant tumor which is originated from epithelial cells.It is mainly characterized by a large number of lymphocytes infiltration around the tumor,the phathological characteristics is similar to nasopharynx carcinoma.The clinical features and prognosis of LELC in different sites are still not clear nowadays.Objectives:1.To study the differences in clinical features and prognosis of LELC between different primary sites;2.To analyze the differences in clinical features and prognosis between head and neck LELC carcinoma and nasopharyngeal undifferentiated carcinoma;3.To explore the clinical characteristics,molecular gene characteristics and prognosis of lung LELC;4.To analyze the differences in clinical features and prognosis between lung LELC and other histological types of lung cancer.Methods:The datas in this paper were from SEER database and Zhujiang Hospital.SPSS was used for statistical analysis of all data,and GraphPad Prism 8 was used for the graph.The P-values of both sides were less than or equal to 0.05,which was considered statistically significant.Results:1.Head and neck LELC patients accounted for a large proportion of LELC patients(56.6%).The clinical features and prognosis of different primary sites of LELC were significantly different(P<0.05).Primary site was an independent prognostic factor for LELC(P<0.001),head and neck LELC had the best prognosis.2.Compared with nasopharyngeal undifferentiated carcinoma,the patients in head and neck LELC were less male,more were older than 53 years old,fewer were married,more were white and distributed in the east and north in West country,more patients had localized stage and accepted surgery,less received radiotherapy and chemotherapy;There was no difference in prognosis between the two groups.3.In the SEER database,the male to female ratio of lung LELC was 1:1.07,the median age of diagnosis was 65 years old,and there were more patients with phaseⅠ/Ⅱ.Among the treatment methods,the patient accepted surgery accounted for 69.5%,chemotherapy accounted for 42.1%,radiotherapy accounted for 22.1%.The proportion of male and female patients in our hospital was balanced,the median age of diagnosis was 56 years old,74.4%of the patients had respiratory symptoms at diagnosis,59.0%of the patients don’t have smoking history,the tumors were mostly located in the left lower lung,and there were more patients in stage Ⅲ/Ⅳ.A small number of patients received surgery,more than half received chemotherapy,fewer patients received radiotherapy and immunotherapy.The EBER positive rate was 94.4%.The expression rate of PD-L1 was 93.8%.No mutations of ALK and EGFR genes were found,EGFR(6/6),P53(7/7),and Bcl-2(2/2)genes had high amplification rates.Age,with or without distant metastasis,and with or without surgery were independent prognostic factors for lung LELC in SEER database(P<0.05).4.Compared with lung LCC(large cell carcinoma)and SCC(squamous cell carcinoma),lung LELC diagnosed more for women,the majority of patients aged less than or equal to 70 years old,with almost all are Asian or white,tend to be distributed in the Pacific coast of America,almost all are poorly differentiated or undifferentiated tumor,more patients were phase I/II,more paients received surgery and chemotherapy,less patients received radiotherapy;The median survival of lung LELC was significantly longer than that of lung LCC and lung SCC(81months vs.7months vs.11months;P<0.001).Conclusion:1.The clinical features and prognosis of LELC vary from different sites,primary site was an in dependent prognostic factor for LELC,head and neck LELC had the best prognosis.2.The clinical features of nasopharyngeal undifferentiated carcinoma and head and neck LELC are significantly different,but the difference of prognosis did’t reach statistical significance.3.Most patients were non-smoking young patients in lung LELC,which was closely related to EBV infection.Gene amplification and PD-L1 expression were common,but driver gene mutation was rare.Most of the patients in the early stage were treated with surgery,while most of the patients in the lated stage were treated with chemotherapy,radiotherapy or combination therapy.4.The prognosis of lung LELC was better than that of lung LCC and lung SCC;There were significant difference of clinical basiline characteristics between lung LCC and Lung SCC;Age,with or without distant metastasis,and whether accepted surgery were independent prognostic factors for lung LELC.