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NSE and prognosis of non-small-cell lung cancer with synchronous brain metastases: Second analysis
Prevention
site), and myeloperoxidase (MPO) (promoter region, Acil restriction site) by PCR-based genotyping assay. The prevalence of GSTM1 null genotype was not significantly different between lung cancer patients and controls (56.2% vs 52.6%). However, the presence of GSTT1 null genotype was associated with a 1.5-fold (CI 1.01-2.23, p = 0.035) increase in the risk of lung cancer. Concurrent lack of the GSTM1 and GSTT1 genes was associated with lung cancer susceptibility (odds ratio 1.58, CI 1.04-2.40, p = 0.025). The allelic variants in GSTP1, CYP1A1, and CYP2E1 were equally distributed in lung cancer patients and controls. The genotype frequencies of mEH (His139/His 139, His139/Arg 139, and Arg 139/Arg 139) in male subjects were significantly different between lung cancer patients and controls (0.695, 0.260, and 0.046, vs 0.751, 0.245, and 0.004, respectively). Compared with the homozygous wild-type genotype, lung cancer risk in male was 1.33 (CI, 0.80-2.19) for the combined heterozygous and homozygous variant genotypes. The N A genotype of MPO was associated with 70% reduced risk of lung cancer (odds ratio, 0.31; 95% CI, 0.13-0.71). These results suggest that genotyping assay of xenobiotic-metabolizing enzymes can be used for screening of indwiduals at high risk for lung cancer.
[-7-~] Patient's and doctors' delay in diagnosis of lung cancer H. Koyi 1, E. Branden 1, G. Hillerdal 2. 1Department of Respiratory
Medicine, Gavle Central Hospital, Gavle; 2Department of Chest Medicine, Karolinska Hospital, Stockholm, Sweden Lung cancer is the most common cause of cancer death in men and the second most important in women in Sweden, even if the incidence is lower than in most similar countries. The most important factor for survival is the stage at diagnosis. Unfortunately, most lung cancers are discovered far too late. Factors such as when the patient contacts his doctor and how efficiently and rapidly a suspected case of lung cancer is referred to the specialist and how the work-up is done are important for the outcome. Details on these important factors are rare in the literature. In the county of Gavleborg, Sweden, with 282 226 inhabitants in 1998, there are 100-120 new cases of lung cancer every year. All new lung cancer patients from the county were investigated prospectively. Stages, type of cancer, symptoms etc were noted, and patient's and doctors' delays were measured in a questionnaire. From February 1, 1997, to February 28, 1998, 127 patients (79 men and 48 women) with lung cancer were diagnosed. The mean age was 70.6, range 39 to 92 years. The delays were classified as follows: patient's delay is the time from first symptom until the patient seeks the doctor, in general his/her GP. The delays of the doctors were divided into two parts: 1/from the time a visit was arranged until the patient was referred to the lung clinic; 2/the time from the lung specialist received until treatment was started or the decision not to treat was tak Results (days): Patient's delay: mean 44.7, median 22 Doctor's delay 1 : mean 26.5, median 8 Doctor's delay 2: mean 54.8, median 33 Conclusion: These delays are very similar to earlier published results. We now aim at shortening them by information to the public, to the GP's, and by streamlining our own methods in the investigations.
•6-•
NSE and prognosis of non-small-cell lung cancer with synchronous brain metastases: Second analysis
X. Quantin, W. Jacot, J. Boher, F. Andre, L. Moreau, M. Gainet, E. Quoix, J.L. Pujoi. The AERIO Study Group; Montpellier University
Hospital, Montpellier; Institut Gustave Roussy, Paris; Strasbourg University Hospital, BesanAon University Hospital, France Patients with Non-Small-Cell Lung Cancer (NSCLC) frequently suffer from synchronous brain metastases. Brain metastases generally indicated a poor prognosis. The knowledge of prognostic determinants might be important in both clinical trials and routine practice. A total of 231 patients was included on this retrospective study. The median survival was 28 weeks (95% CI 24-34 weeks). Were of poor prognosis for survival in univariate analysis (log-rank): brain metastases-related symptoms (p < .0019), male sex (p < .0004), age over 63 years (p <
223
.04), poor ECOG performance status (p < .0003), serum sodium below 132 mM/I (p < 0.014), high serum LDH level (p < .036), high serum alkaline phosphatases level (p < .008), serum Neuron Specific Enolase (NSE) higher than 12.5 mglml (p < .0015). Multivariate analysis: due to the lack of proportionality of hazard ratio for age, Coxis model was stratified upon this variable. Were of poor prognosis for survival: male gender (HR 1.659, p < .0021), poor ECOG performance status (HR 1.541, p < .001), high serum NSE level (HR 1.658, p < .005), brain metastases-related symptoms (HR 1.431, p < .033). PS and sex are prognostic determinants of NSCLC patients affected by brain metastases as already demonstrated in general stage IV NSCLC population. Prognostic value of a high serum NSE level is an original result in brain metastases. The reason of this association is not univocal, i) It could be the sign of a phenotypic diversification, reflecting a more aggressive disease, ii) NSE can be released from peritumoral damaged neuronal cells and its serum level has been recently correlated to the infarction volume and prognosis in acute ischemic stroke.
~-~
Smoking cessation duration: Evaluation of prognostic determinants X. Quantin, M. Bozonnat, J. Pujol, J. Daures. Montpellier Univesity Hospital, Montpellier; Institut Universitaire de Rechcerche Clinique, Montpellier, France This study investigated the prognostic determinants to achieve smoking cessation in a population of smokers who were volunteers to take parts in the Montpellier University smoking cessation programme. This programme included the use of nicotine substitute. The survival was defined as the time from the start of smoking cessation to the time of relapse of smoking consumption. Probability of survival was estimated by the Kaplan-Meier method. Variables tested in univariate (log-rank) and multivariate analysis (Cox's proportional hazard model) were: gender, age, age at smoking initiation, daily cigarette consumption, number of cigarettes smoke in the first hour after awakening, nicotine dependence score, comorbidity, depression history, excessive alcohol consumption history, treatment for psychiatric disorders reason for smoking cessation, use of nicotine substitute, group therapy. One hundred and one consecutive subjects were include into the study from January to December 1996. Baseline characteristic of the subjects were as follows: male/female: 50/51, 43 +/- 12 years, age at smoking initiation: 17 +/- 0.5 years, cigarettes day: 29 +/- 13, number of previous attempt for smoking cessation 1.3 +/- 1.2, use of nicotine substitute: 40%, depression history: 30%, history of excessive alcohol drinking: 31%, treatment for psychiatric disorders 18%. Female gender was in far excess in comparison with the low prevalence of smoking in French female. Nicotine dependence, lack of nicotine substitution were associated with a poor survival i.e. a short duration of smoking abstinence. The median duration of smoking cessation was 3.8 vs 10.9 months with nicotine substitution In the cox proportional hazard model only the nicotine substitution predicted a prolonged smoking cessation (RR: 0.505, p = 0.0011). In conclusion: This study confirm the high rate of depressive mood and alcoholism history in smokers. Nicotine substitution is of paramount importance in a smoking cessation programme. Because nicotine substitution is safe, it might be widely offered to smokers.
~-6--~ Clinical features and survival of 138 small cell lung cancer cases from Turkey M. Gulhan, A. Erturk, E.B. Kurt, N. Capan. Ataturk Center for Chest Diseases and Toracic Surgery, Ankara, Turkey In this study, it was aimed to evaluate the clinical features and survival of small cell lung carcinoma cases diagnosed in our clinic between 1992-1999. One hundred-thirtyeight patients, 129 men, 9 women with the mean age of 55 + - 0.77, were included in the study retrospectively. 92.3% of male and 33.3% of female patients were current smokers. The most common radiologic findings were right central masses. Superior vena cava syndrome was present in 12 patients (8.6%) at
site), and myeloperoxidase (MPO) (promoter region, Acil restriction site) by PCR-based genotyping assay. The prevalence of GSTM1 null genotype was not significantly different between lung cancer patients and controls (56.2% vs 52.6%). However, the presence of GSTT1 null genotype was associated with a 1.5-fold (CI 1.01-2.23, p = 0.035) increase in the risk of lung cancer. Concurrent lack of the GSTM1 and GSTT1 genes was associated with lung cancer susceptibility (odds ratio 1.58, CI 1.04-2.40, p = 0.025). The allelic variants in GSTP1, CYP1A1, and CYP2E1 were equally distributed in lung cancer patients and controls. The genotype frequencies of mEH (His139/His 139, His139/Arg 139, and Arg 139/Arg 139) in male subjects were significantly different between lung cancer patients and controls (0.695, 0.260, and 0.046, vs 0.751, 0.245, and 0.004, respectively). Compared with the homozygous wild-type genotype, lung cancer risk in male was 1.33 (CI, 0.80-2.19) for the combined heterozygous and homozygous variant genotypes. The N A genotype of MPO was associated with 70% reduced risk of lung cancer (odds ratio, 0.31; 95% CI, 0.13-0.71). These results suggest that genotyping assay of xenobiotic-metabolizing enzymes can be used for screening of indwiduals at high risk for lung cancer.
[-7-~] Patient's and doctors' delay in diagnosis of lung cancer H. Koyi 1, E. Branden 1, G. Hillerdal 2. 1Department of Respiratory
Medicine, Gavle Central Hospital, Gavle; 2Department of Chest Medicine, Karolinska Hospital, Stockholm, Sweden Lung cancer is the most common cause of cancer death in men and the second most important in women in Sweden, even if the incidence is lower than in most similar countries. The most important factor for survival is the stage at diagnosis. Unfortunately, most lung cancers are discovered far too late. Factors such as when the patient contacts his doctor and how efficiently and rapidly a suspected case of lung cancer is referred to the specialist and how the work-up is done are important for the outcome. Details on these important factors are rare in the literature. In the county of Gavleborg, Sweden, with 282 226 inhabitants in 1998, there are 100-120 new cases of lung cancer every year. All new lung cancer patients from the county were investigated prospectively. Stages, type of cancer, symptoms etc were noted, and patient's and doctors' delays were measured in a questionnaire. From February 1, 1997, to February 28, 1998, 127 patients (79 men and 48 women) with lung cancer were diagnosed. The mean age was 70.6, range 39 to 92 years. The delays were classified as follows: patient's delay is the time from first symptom until the patient seeks the doctor, in general his/her GP. The delays of the doctors were divided into two parts: 1/from the time a visit was arranged until the patient was referred to the lung clinic; 2/the time from the lung specialist received until treatment was started or the decision not to treat was tak Results (days): Patient's delay: mean 44.7, median 22 Doctor's delay 1 : mean 26.5, median 8 Doctor's delay 2: mean 54.8, median 33 Conclusion: These delays are very similar to earlier published results. We now aim at shortening them by information to the public, to the GP's, and by streamlining our own methods in the investigations.
•6-•
NSE and prognosis of non-small-cell lung cancer with synchronous brain metastases: Second analysis
X. Quantin, W. Jacot, J. Boher, F. Andre, L. Moreau, M. Gainet, E. Quoix, J.L. Pujoi. The AERIO Study Group; Montpellier University
Hospital, Montpellier; Institut Gustave Roussy, Paris; Strasbourg University Hospital, BesanAon University Hospital, France Patients with Non-Small-Cell Lung Cancer (NSCLC) frequently suffer from synchronous brain metastases. Brain metastases generally indicated a poor prognosis. The knowledge of prognostic determinants might be important in both clinical trials and routine practice. A total of 231 patients was included on this retrospective study. The median survival was 28 weeks (95% CI 24-34 weeks). Were of poor prognosis for survival in univariate analysis (log-rank): brain metastases-related symptoms (p < .0019), male sex (p < .0004), age over 63 years (p <
223
.04), poor ECOG performance status (p < .0003), serum sodium below 132 mM/I (p < 0.014), high serum LDH level (p < .036), high serum alkaline phosphatases level (p < .008), serum Neuron Specific Enolase (NSE) higher than 12.5 mglml (p < .0015). Multivariate analysis: due to the lack of proportionality of hazard ratio for age, Coxis model was stratified upon this variable. Were of poor prognosis for survival: male gender (HR 1.659, p < .0021), poor ECOG performance status (HR 1.541, p < .001), high serum NSE level (HR 1.658, p < .005), brain metastases-related symptoms (HR 1.431, p < .033). PS and sex are prognostic determinants of NSCLC patients affected by brain metastases as already demonstrated in general stage IV NSCLC population. Prognostic value of a high serum NSE level is an original result in brain metastases. The reason of this association is not univocal, i) It could be the sign of a phenotypic diversification, reflecting a more aggressive disease, ii) NSE can be released from peritumoral damaged neuronal cells and its serum level has been recently correlated to the infarction volume and prognosis in acute ischemic stroke.
~-~
Smoking cessation duration: Evaluation of prognostic determinants X. Quantin, M. Bozonnat, J. Pujol, J. Daures. Montpellier Univesity Hospital, Montpellier; Institut Universitaire de Rechcerche Clinique, Montpellier, France This study investigated the prognostic determinants to achieve smoking cessation in a population of smokers who were volunteers to take parts in the Montpellier University smoking cessation programme. This programme included the use of nicotine substitute. The survival was defined as the time from the start of smoking cessation to the time of relapse of smoking consumption. Probability of survival was estimated by the Kaplan-Meier method. Variables tested in univariate (log-rank) and multivariate analysis (Cox's proportional hazard model) were: gender, age, age at smoking initiation, daily cigarette consumption, number of cigarettes smoke in the first hour after awakening, nicotine dependence score, comorbidity, depression history, excessive alcohol consumption history, treatment for psychiatric disorders reason for smoking cessation, use of nicotine substitute, group therapy. One hundred and one consecutive subjects were include into the study from January to December 1996. Baseline characteristic of the subjects were as follows: male/female: 50/51, 43 +/- 12 years, age at smoking initiation: 17 +/- 0.5 years, cigarettes day: 29 +/- 13, number of previous attempt for smoking cessation 1.3 +/- 1.2, use of nicotine substitute: 40%, depression history: 30%, history of excessive alcohol drinking: 31%, treatment for psychiatric disorders 18%. Female gender was in far excess in comparison with the low prevalence of smoking in French female. Nicotine dependence, lack of nicotine substitution were associated with a poor survival i.e. a short duration of smoking abstinence. The median duration of smoking cessation was 3.8 vs 10.9 months with nicotine substitution In the cox proportional hazard model only the nicotine substitution predicted a prolonged smoking cessation (RR: 0.505, p = 0.0011). In conclusion: This study confirm the high rate of depressive mood and alcoholism history in smokers. Nicotine substitution is of paramount importance in a smoking cessation programme. Because nicotine substitution is safe, it might be widely offered to smokers.
~-6--~ Clinical features and survival of 138 small cell lung cancer cases from Turkey M. Gulhan, A. Erturk, E.B. Kurt, N. Capan. Ataturk Center for Chest Diseases and Toracic Surgery, Ankara, Turkey In this study, it was aimed to evaluate the clinical features and survival of small cell lung carcinoma cases diagnosed in our clinic between 1992-1999. One hundred-thirtyeight patients, 129 men, 9 women with the mean age of 55 + - 0.77, were included in the study retrospectively. 92.3% of male and 33.3% of female patients were current smokers. The most common radiologic findings were right central masses. Superior vena cava syndrome was present in 12 patients (8.6%) at