Prognosis of patients with non small cell lung cancer (NSCLC) remains difficult to assess, even after adjustment for pathological stage. Prognostic value of numerous biological markers has been evaluated, with conflicting results. Data of 86 patients with NSCLC treated by surgery were collected with clinical characteristics, histopathological data including tumor differentiation and status of blood and lymphatic vessel invasion and evaluation by immunohistochemistry of Rb, Bcl-2 and Ki-67 expression. Prognostic values for overall survival (OS) and event-free survival (EFS) were analyzed by the log tank test and the multivariable Cox model. Using univariable analyses, pT, pN, poor differentiation or large cell subtype were associated with a poor OS, while lymphatic and/or blood vessel invasion were associated with a short EFS. None of the molecular markers had a significant prognostic value for either outcome. In multivariable analyses, only stage remained of prognostic value for OS. Interestingly, the presence of blood vascular invasion in the tumor was significantly predictive for subsequent metastatic occurrence in stages I and II. This feature might, therefore, be relevant for administration of adjuvant therapy in completely resected NSCLC.

Aged↗

PubMed2001

[Management of carcinomatous metastatic pleurisy with unknown primary neoplasm].

The primary cancer remains unknown in about 7% of all cases of metastatic carcinomatous pleurisy. Thoracoscopic pleural biopsy provide good quality histology material. The pathology examination, including immunohistochemistry using a panel of well-defined antibodies can provide the diagnosis of neoplastic pleurisy of malignant carcinomatous proliferation, and help search for differentiation and rule out an identifiable primary carcinoma. When histology does not provide a satisfactory clue to the primary cancer, frequent origins include lung cancer, breast or ovary cancer in women, prostate cancer in men, and digestive tract cancer. The possible contribution of positron emission tomography remains to be evaluated. Several chemotherapy protocols can be proposed but the beneficial effect has been difficult to assess due to the heterogeneous nature of the histological forms treated. The carboplatin-paclitaxel-etoposide protocol appears to be promising in cases with an unknown primary cancer but there has been no specific assessment of this chemotherapy schedule in a subgroups of patients with carcinomatous pleurisy with an unknown primary cancer. Better understanding of the biological profile of highly metastatic cancers should be helpful in determining more targeted therapeutic schemes.

Humans↗

PubMed2000

[Role of carboplatin in the treatment of lung cancer].

Carboplatin is a cytotoxic drug used in non-small cell and small cell lung cancer. Its role in advanced disease, but also in combination with radiotherapy, in neoadjuvant treatment and in the treatment approach in elderly patients is reviewed. New cytotoxic drug combinations are described.

Adult↗

PubMed1999

The addition of cisplatin to cyclophosphamide-doxorubicin-etoposide combination chemotherapy in the treatment of patients with small cell lung carcinoma: A randomized study of 457 patients. "Petites Cellules" Group.

BACKGROUND: To assess whether the addition of cisplatin (100 mg/m(2) administered intravenously on Day 1) to CDE (cyclophosphamide [1000 mg/m(2) on Day 1], doxorubicin [45 mg/m(2) on Day 1], and etoposide [150 mg/m(2) on Days 1 and 2] combination is useful in the treatment of patients with small cell lung carcinoma (SCLC). METHODS: In a multicenter clinical trial, 457 patients were randomized from May 1988 to March 1993 to receive either CDE (n = 228) or cisplatin-CDE (PCDE, n = 229) chemotherapy every 4 weeks for 6 cycles. As patients with limited SCLC were included in a concomitant trial assessing thoracic radiotherapy, the current study mainly included patients with extensive stage (79%) or limited stage disease and a contraindication for thoracic radiotherapy. RESULTS: The objective response rate was higher in the cisplatin-CDE group (72%) than in the CDE group (53%) (P = 0.0001). The median overall survival was similar for the groups that received CDE (266 days) and PCDE (271 days) (P = 0.93, log rank test). A higher fatal neutropenia rate was observed in the PCDE group (n = 23) than in the CDE group (n = 4) (P < 0.001, log rank test), mainly for patients with extensive disease (n = 26; P = 0.015, log rank test). CONCLUSIONS: The addition of cisplatin to a CDE regimen is toxic to patients with extensive SCLC and does not improve overall survival. The PCDE combination must be avoided for patients with extensive SCLC; CDE or cisplatin-etoposide combinations remain standard chemotherapy for these patients. The PCDE combination associated with granulocyte-colony stimulating factors could only be assessed in patients with good prognoses.

Aged↗

PubMed1999

A randomized clinical trial comparing concurrent and alternating thoracic irradiation for patients with limited small cell lung carcinoma. "Petites Cellules" Group.

BACKGROUND: Although thoracic radiotherapy is considered to be useful for the treatment of patients with small cell lung carcinoma (SCLC), its optimal administration schedule is still controversial. METHODS: In a multicenter clinical trial, 164 patients with limited SCLC (of whom 156 were eligible for the study) were randomized to receive either concurrent thoracic irradiation, initiated immediately after the second cycle of chemotherapy (Days 30-64) at a dose of 50 grays in 20 fractions, or alternating thoracic irradiation, scheduled in 3 courses between the second, third, fourth, and fifth cycles of chemotherapy with a 7-day rest period after and before chemotherapy at a dose of 20 grays in 8 fractions (Days 36-47 and Days 64-75) and then 15 grays in 6 fractions (Days 92-101). The same chemotherapy regimen (cyclophosphamide-doxorubicin or vindesine-etoposide) was administered every 4 weeks in both groups. RESULTS: Concurrent radiotherapy-induced lung toxicity led to early termination of this trial when a significant difference was observed (6 cases vs. 1, P = 0.05, 2-sided log rank test). Objective response rates were 89% in the 82 patients of the concurrent radiotherapy group and 95% in the 74 patients of the alternating radiotherapy group. Median survival periods were 13.5 and 14.0 months, respectively, with no significant difference between the two survival distributions (P = 0.15, 2-sided log rank test). Toxic deaths due to bone marrow hypoplasia were similar in both groups (3 vs. 2), but mortality due to lung toxicity (pulmonary fibrosis) was more frequent with concurrent radiotherapy (6 patients) than with alternating radiotherapy (1 patient) in long term analysis (P = 0.05, 2-sided log rank test). CONCLUSIONS: Although no statistically significant overall survival difference was observed between the two radiation therapy schedules, the better tolerance of the alternating schedule justifies the choice of this schedule with this chemotherapy regimen, although it may not be applicable to other chemotherapy regimens.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1999

[The lung and benign diseases of the ovary].

Two main benign diseases of the ovary which can simulate advanced stage cancer of the ovary are described. The first is Meigs' syndrome, a triad of benign ovarian tumor, usually an ovarian fibroma, ascitis, and pleural effusion with complete disappearance of serous exsudative effusions with surgical resection of the ovarian tumor. The second is ovarian hyperstimulation syndrome following ovulation induction with exogenous gonotropins for the treatment of infertility. This syndrome associates significant ovarian enlargement, hyperestrogenism and latent or clinically patent serous exsudative effusions; it usually resolves with suggestive measures and rest.

Female↗

PubMed1998

Different pattern of MRP localization in ciliated and basal cells from human bronchial epithelium.

The MRP (multidrug resistance-associated protein) transmembrane transporter, which actively transports a wide variety of lipophilic substrates out of cancer cells, has been suggested to play a major role in cell detoxification via efflux of glutathione conjugates. Because bronchial epithelial cells are constantly exposed to environmental pollutants, MRP might be a particularly important defense mechanism against xenobiotics. This study was therefore designed to investigate MRP localization by immunohistochemistry in bronchial epithelial cells collected by scraping from surgical specimens. In parallel, MRP mRNA was detected by reverse transcriptase chain reaction (rt-PCR) in bronchial cell lysates. However, the pattern of protein expression differed markedly according to cell type. In ciliated epithelial cells, immunostaining was restricted to the basolateral surface, without any labeling at the apical surface, which is at variance with the localization of CFTR and MDR1 proteins, other members of the same family of transporters. In basal cells, MRP was present over the entire circumference of the plasma membrane. Basal cells were identified by their morphology and specifically after incubation with an anticytokeratin 17 monoclonal antibody. In conclusion, the different patterns of localization suggest specific roles for MRP in basal and ciliated cells.

ATP-Binding Cassette Transporters↗

PubMed1998

[Unusual cause of necrotized subacute pneumopathy].

We report a case of Streptococcus milleri (S. intermedius) pulmonary infection in a 66-year-old woman. The patient was a heavy smoker and had diabetes. The diagnosis was proven by transparietal pulmonary aspiration.

Aged↗

PubMed1998

[Cell cycle, tumor suppressor genes and lung cancers].

Uncontrolled proliferation is the characteristic of cancer. Several kinds of genes control the cell cycle: oncogenes, tumor suppressor genes, and genes implicated in apoptosis or survival. Two major pathways of control are frequently disrupted in human cancer. The first one is the RB pathway with inactivation of the RB protein (retinoblastoma protein), either by alteration of the retinoblastoma gene itself, or by genetic alterations of the genes implicated in RB phosphorylation. The second one is the inactivation of the p53 protein. Both of these abnormalities are described in human lung carcinoma but differ according to histologic subtype.

Apoptosis↗

PubMed1997

Diagnostic and prognostic value of Cyfra 21-1 compared with other tumour markers in patients with non-small cell lung cancer: a prospective study of 116 patients.

The diagnostic value of Cyfra 21-1 in non-small lung cancer (NSCLC) has been established, but few studies have focused on its prognostic value. The aim of this study was to compare that of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, CA 125, neuron-specific enolase and squamous cell carcinoma antigen. 116 patients with unresectable (n = 88) or resectable (n = 28) NSCLC were prospectively monitored from diagnosis, for a median of 14.4 months. All patients underwent tumour-marker determinations before treatment, then every 3 months. Their diagnostic value was studied using ROC (receiver operating characteristic) curves, based on control measure in 23 patients with benign lung diseases. The prognostic analysis was based on overall survival as the main endpoint. The diagnostic value of Cyfra 21-1 was confirmed, with a sensitivity of 54% and a specificity of 96% at a cut-off value of 3.3 ng/ml. At diagnosis, in the 88 non-surgical NSCLC, besides the presence of metastases (P = 0.017), Cyfra 21-1 (P = 0.017) and CA 125 (P = 0.03) were related to outcome. Elevated levels of Cyfra 21-1 at any time during the disease course was selected by multivariate analysis as additional predictors of poor survival.

Adult↗

PubMed1997

[Second primary cancers after small-cell lung cancer].

The records of 1,371 patients with small cell carcinoma of the lung (SCLC) treated between 1983 and 1994, were reviewed for the occurrence of second primary malignancies (SPM). One was excluded for analysis because of insufficient data. Eight synchronous SPM (SSPM) and 8 metachronous SPM (MSPM) were identified, SSPM included non-small cell lung cancer in 6 patients, 1 head and neck cancer and 1 oesophageal cancer. Median survival after the diagnosis of SSPM was 6 months. The MSPM were detected between 1 and 6 years after the diagnosis of SCLC. MSPM included lung cancer (3 patients), gastrointestinal malignancies (2 patients), 1 hematologic malignancy, 1 prostatic cancer and 1 head and neck cancer. The median survival time after the diagnosis of MSPM was 4 months. Occurrence of SPM is a singular pattern of patients with SCLC. Tobacco consumption, genetic factors and carcinogenic effects of multimodality treatment are supposed mechanisms to explain SPM.

Adult↗

PubMed1996

Blood vessel and lymphatic vessel invasion in resected nonsmall cell lung carcinoma. Correlation with TNM stage and disease free and overall survival.

BACKGROUND: The objective of this prospective study was to assess in 96 patients with resected nonsmall cell lung carcinoma (NSCLC) the prevalence of both blood and lymphatic vessel invasion (BVI and LVI) according to stage, as well as their prognostic value for disease free and overall survival. METHODS: BVI and LVI were evaluated by hematoxylin and eosin stains on surgical specimens after resection. Associations among variables were tested by Fisher's exact test or the chi-square test; prognostic values on time-failure data were analyzed by the log rank test and the multivariate Cox model. RESULTS: BVI was present in 52% of NSCLC cases and LVI in 59%. Venous but not arterial vascular invasion correlated with the T factor and pTNM, whereas LVI correlated with the N factor and pTNM. In univariate analysis, LVI but not BVI was associated with a short disease free interval (P = 0.0007) and poor survival (P = 0.0001). The estimated relative risk of death in patients with LVI was 3.2 compared with patients without LVI. In multivariate analysis, LVI and pTNM were additional predictors for poor disease free and overall survival. In this series, BVI had no prognostic value. CONCLUSIONS: The prevalence of BVI and LVI appeared high in patients with NSCLC, especially those with advanced pTNM stages. LVI was predictive of poor outcome, both time to recurrence and death.

Adenocarcinoma↗

PubMed1995

[Tuberculosis in a Parisian pneumology department: 151 cases].

OBJECTIVES: The incidence of tuberculosis has risen since 1992. We studied cases observed in our department to search for factors favouring this increased incidence. METHODS: A retrospective assessment of 151 cases of tuberculosis observed over a 3 year period in a department of pneumology in Paris was performed. RESULTS: Fifty-two percent of the patients were foreigners; 66% lived in a poor socio-economic environment included 18% with no permanent residence; 29% were alcoholics. An association with human immunodeficiency virus infection was seen in 7% of the cases. Another immunodepression factor was found in 15%. Tuberculosis was discovered in a context of respiratory distress in 7% or the patients. Outcome was fatal in 6%. Three months after diagnosis 22% of the patients were lost to follow-up. CONCLUSION: This series emphasizes the major role of socio-economic factors in the rising incidence of tuberculosis and the need for urgent and adapted measures for therapeutic management in an often non-compliant and socially instable population.

AIDS-Related Opportunistic Infections↗

PubMed1994

Myelitis due to Toxoplasma gondii in a patient with AIDS.

Explore the source record for details and available documents.

AIDS-Related Opportunistic Infections↗