Clinical Features And Prognosis Analysis Of Primary Pulmonary Lymphoepithelioma-like Carcinoma

Objective:Primary pulmonary lymphoepithelioma-like carcinoma(PPLELC)is a rare disease in clinical practice.It is poorly understood in clinical practice.Therefore,misdiagnosis and missed diagnosis often exist in the past diagnosis.The aim of this study is to sum up the characteristics,imaging features,immunohistochemical features,treatment plans and prognosis of PPLELC patients,so as to further promote the understanding of the characteristics of pulmonary lymphoepithelioma-like carcinoma in the medical field,and to help the diagnosis,prognosis assessment and provision of more effective treatment plans for this cancer in the future.Methods: We retrospectively analyzed the PPLELC patients,who treated in the First Affiliated Hospital of Guangxi Medical University during the 9 years from January 2012 to January 2021,collected clinical medical records,and summarized the clinical features,imaging findings,pathological and immunohistochemical features of PPLELC patients.The above data of the patients were summarized,followed up and analyzed,and prognostic factors related to them were determined.Result: A total of 35 patients with PPLELC were included in our study,with a median age of 52 years old(34-74 years old)and a similar male to female ratio(16 cases vs.19 cases).68.6% of the patients had no smoking history.The onset of symptoms of cough with/without sputum(48.6%)and asymptomatic due to physical examination(45.7%)were more common.Most of the lesions were peripheral type(65.6%),most of the tumors had clear boundary(77.1%),were lobulated(56.2%),accompanied by burr sign(71.8%),and could be accompanied by complications such as obstructive pneumonia(31.4%)and pleural effusion(18.8%).EBER(91.7%),CK(100%),P63(100%),CK5/6(100%)were positive expressions,TTF-1,SYN,CD5 and CD56 were negative expressions.In terms of treatment,surgery or postoperative adjuvant therapy was performed according to stages.The overall OS rate was 82% at 2years,75% at 5 years,the longest survival time was 91 months.Lymphatic metastasis affected the prognosis of patients(P[PFS]=0.002,P[OS]=0.01).Conclusion: Patients with PPLELC were mostly diagnosed with respiratory symptoms.On CT imaging,peripheral consolidation was more common,with clear boundaries,and could be lobulated with burr sign.In immunohistochemistry,CK,P63,CK5/6 were mainly positive expressions,and EBER was highly expressed,with obvious pathological characteristics.The presence of lymphatic metastasis is a significant factor affecting the prognosis of patients.In terms of treatment,it is suggested to take surgical treatment as the basis and combined treatment with radiotherapy and chemotherapy according to stages.