Clinical Characteristics And Prognosis Of Non-Surgically Treated Pneumonic-Type Adenocarcinoma

Background: Pneumonic-type adenocarcinoma is a subtype of lung adenocarcinoma.Delay in diagnosis is not rare in this subtype due to its non-specific clinical manifestation which results in patients losing their opportunity of early surgical treatment.Non-surgically treated pneumonic-type adenocarcinoma patients usually have more advanced or complex conditions,which remain poorly understood and pose a major challenge in clinical management.We aimed to describe the clinical profiles and prognosis of non-surgically treated pneumonic-type adenocarcinoma patients.Method: We enrolled patients with pathologically proven pneumonic-type adenocarcinoma in the First Affiliated Hospital of Chongqing Medical University from June,2013 to August,2016.We performed a medical review of all patients,gathered information including clinical manifestation,radiological features,laboratory findings,treatment,survival time.According to the different treatment,these patients were divided into chemotherapy group,EGFR-TKIs therapy group,palliativecare group,and sequential therapy group.Analysis were performed by IBM SPSS 22.0 software.Result: We enrolled 71 patients with pneumonic-type adenocarcinoma proven pathologically and radiologically.Their median age was 62 years,including 45% men and 35% smokers.Clinical manifestations were dominated by cough,sputum and dyspnea.Main chest imaging features included nodules,shadow,consolidation and air bronchogram that are easily confused with pulmonary infectious diseases.Nearly half or more of patients showed elevated levels of inflammation and cancer biomarkers including Cytokeratin-19-fragmen(CYFRA21-1)and Carcinoembryonic antigen(CEA).There was no statistical heterogeneity in general conditions,clinical manifestations,laboratory examinations and stage of cancer among four treatment groups but there was statistical difference in their survival time(P=0.026).EGFR-TKIs therapy(P=0.034)and sequential therapy(P=0.016)provided longer survival time than palliative care.While there was no significant difference in the survival time among chemotherapy group,EGFR-TKIs therapy group and sequential therapy group.An increase in serum CEA(P=0.039)was associated with better prognosis while an increase in serum CYFRA21-1(P=0.004)could predict a poor prognosis.Detailed understanding the clinical characteristics and prognostic factors in non-surgically treated pneumonic-type adenocarcinoma may allow the identification of patients with particular riskfactors and initiation of early and specific treatment in order to optimize outcomes.Conclusion: EGFR-TKIs therapy,chemotherapy and sequential therapy could make overall survival longer than palliative care while no one has shown unique advantage.An increase in serum CEA was associated with better prognosis while elevated serum CYFRA21-1 could predict a poor prognosis for pneumonic-type adenocarcinoma.