Lung carcinomas: Epidemiological, histological, immunohistochemical and evolving data about a cases series of 399 patients in Fez (Morocco)

Background: Lung cancer is the leading cause of cancer death worldwide; non-small cell lung carcinoma (NSCLC) is the most common, accounting for 85% of all lung carcinomas. Methods: This was a retrospective study of 399 cases of lung carcinomas who were managed between January 2011 and December 2016 at surgical pathology department at Hassan II university hospital of Fez (Morocco). The clinical, radiological, histopathological, immunohistochemical and evolving details were collected from patients’s files. Results: There were 316 men (79%) and 83 women (21%), with a mean age of 59 years. The tumors size was classified as T1 (2%), T2 (19 %), T3 (15 %) and T4 (64%) According to the 2009 UICC TNM classification, the majority of cases were in stage IV (82%). Histological examination found 262 adenocarcinomas (66%), 78 squamous cell carcinomas (18%), 47 neuroendocrine noeoplasms (11 %), 16 metastasis (2,3%) and 2 carcinomas NOS. The immunohistochemical staining was done in 365 cases (92%). Cytokeratin7 was positive in 84% of cases, including 93% (214) adenocarcinomas versus 4% (9) neuroendocrine carcinomas and 3% (7) epidermoid carcinomas (p = 0.000001). TF1 was positive in 55% of cases with 86% (158) adenocarcinomas, 14% (24) neuroendocrine carcinomas and 0% squamous cell carcinomas. CK5 / 6 was positive in 86% (35) squamous cell carcinomas versus 14% (6 cases) adenocarcinomas. P63 was positive in 99.7% of the squamous cell carcinomas versus 0.3% of adenocarcinomas. Chromogranin A and synaptophysin were positive in 100% of neuroendocrine tumors. Overall, a discordant intratumoral immunohistochemical heterogeneity was rarely observed. Although TTF-1 appeared specific (97.3%) and sensible (86.2%) in the diagnosis of adenocarcinoma. After a median follow-up of 11 months [3-28 months], the median overall survival was 23 months. Overall survival rates were 50% at 23 months. In univariate analysis, 5 factors were statistically associated with overall survival. These factors are the histological type (adenocarcinoma versus squamous cell carcinoma versus neuroendocrine neoplasm), size tumor (T1-2 vs T3-4), lymph node status (N0 vs N +), stage of disease (I-II vs III-IV) And the performance score (PS 0-1 vs PS2-3-4) (Table 8). It is noted that overall survival is improved in patients under the age of 60 years, female, performance statute (PS 0 or 1), non-smoking, with adenocarcinoma, localized with a small size tumor (T1 / 2) and N0. Conclusion: Lung cancer are the leading cause of death in men worldwide, and, for many years, researchers are struggling to stop its progression and improve prognosis. In our experience locally advanced and metastatic adenocarcinomas are most common with a mean decrease of survival for delays diagnosis and the management, which joins the literature data.