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Original Article

Squamous cell carcinoma of the lung: clinical criteria for treatment
strategy

Agnese Savini, Rossana Berardi, Paola Mazzanti, Miriam Caramanti, Matteo Santoni, Mariagrazia De Lisa,
Francesca Morgese, Silvia Rinaldi, Mariangela Torniai, Ilaria Fiordoliva, Azzurra Onofri, Stefano Cascinu
Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy.
Correspondence to: Dr. Rossana Berardi, Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria
Ospedali Riuniti, Umberto I, GM Lancisi, G Salesi di Ancona Via Conca 71, 60126 Ancona, Italy. E-mail: r.berardi@univpm.it

ABSTRACT
Aim: Primary lung cancer is the leading cause of human cancer deaths worldwide, and squamous cell carcinoma (SCC) is one of
the most frequent histologic subtypes. The aim of our study was to analyze clinical factors potentially affecting the overall outcome
of advanced lung SCC patients. Methods: A series of 72 consecutive patients with advanced SCC undergoing chemotherapy
at our institution between January 2007 and July 2013 were eligible for our analysis. Results: By univariate analysis, a better
overall survival (OS) was related to response to fi rst-line chemotherapy: median OS were 19.7 vs. 7.17 months, respectively,
for responders and nonresponders patients (P < 0.0001). Eastern Cooperative Oncology Group performance status, gender,
and surgery were other prognostic factors. No signifi cant relationship between OS and smoking status, age, body mass index,
or type of treatment was found. In the third-line setting, a better OS was associated with objective response to second-line
treatment (P = 0.015). Conclusion: Our results suggest that differences in OS seem strictly associated with clinical response to
previous treatments. These data should be considered in the therapeutic strategy and management of patients with SCC of the lung.
Key words: Non-small cell lung cancer, prognostic factors, squamous cell carcinoma

Introduction typically absent in SCC, and targeted agents developed
[5]
for ADC are largely ineffective against SCC. The aim
Squamous cell carcinoma (SCC) represents 25-30% of our study was to analyze clinical factors potentially
of all non-small cell lung cancer (NSCLC). It is due affecting the outcome of advanced SCC in clinical
[1]
to the transformation of bronchial epithelium caused practice. This was done to identify criteria that can help
primarily by cigarette smoking and shows a remarkable physicians to select the best treatment strategy in their
dose-dependence with it. Typically, SCC originates in clinical settings.
bronchial airways, in particular, those proximal and of
medium caliber while adenocarcinoma (ADC) occurs in Methods
about 50% of cases and is localized to bronchi of smaller
diameter. ADC is the most frequent histological type in The study includes patients with locally advanced or
nonsmokers, and its pathogenesis differs from SCC. metastatic (tumor-node-metastasis (TNM) stage III-IV)
SCC of the lung undergoing chemotherapy at our institution
In general, SCC tends to be locally aggressive with between January 2007 and July 2013. Age, smoking
metastasis to distant organs occurring less frequently than history, sex, Eastern Cooperative Oncology Group
in ADC. New treatment options for ADC underline the (ECOG) performance status (PS), body mass index (BMI),
need for mandatory subtyping. In particular, mutations and pathological stage of disease (TNM) were included in
[2]
in the epidermal growth factor receptor (EGFR) kinase, recorded patient characteristics and clinical features. The
as well as fusions involving anaplastic lymphoma following data were collected for each patient: fi rst and
kinase (ALK), have led to a remarkable improvement second-line chemotherapy details and surgical resection
in personalized therapy for ADC. [3,4] Unfortunately, or radiotherapy information if performed. Tumor response
activating mutations in EGFR and ALK fusions are was evaluated according to the Response Evaluation
Criteria in Solid Tumors (RECIST 1.1).
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The statistical association between categorical variables
Quick Response Code: and clinical outcome was assessed with a Chi-square
Website:
www.jcmtjournal.com test. We used Kaplan-Meier analysis to measure survival
distribution. Tested variables included sex (male vs. female),
age (> 65 vs. ≤ 65), ECOG PS (0 vs. ≥ 1), BMI (< 25 vs.
DOI:
10.4103/2394-4722.157974 25-29.9 vs. ≥ 30), smoking status (never smoker vs. smoker/
former smoker), stage (III vs. IV), surgery (surgery vs. not

90 Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 2 ¦ July 15, 2015 ¦