HLA antigens and bronchogenic carcinoma in the Greek population

129 classification tree by the following eight attributes: DE, PS, serum AP, serum LDH. mediastinal spread, sex, WBCC, and liver metastasis. The four groups were distinguished by median survival umes of 59,49,35, and 24 weeks, respectively (P = .OOOl).Interactions among prognostic factors are emphasized in the RECPAM classification model as evidenced by reassignment of patients across conventional staging barriers into alternate prognostic groups. The advantages of using RECPAM over the more convenhonai Cox regression techniques for a new staging system are discussed. Survival determinants in extensive-stage non-small-cell lung cancer: The Southwest Oncology Group experience Albain KS, Crowley II, J_eBlanc M, Livingston RB. Southwest Oncology Group, Operarions Ofice, 5430 Fredericksburg Rd. San Anmnio. 7X 78229-6197. J Clin Oncol 1991;9:1618-26. We analyzed the 2,531-patient Southwest Oncology Group extensive-stage non-small-cell lung cancer (ENSCLC) data base from 1974 to 1988 to(l)assessthe interactionsofhost-ortumor-relatedprognostic factors and therapy using Cox modeling and recursive partitioning and amalgamation (RPA) to determine whether each independently predicts outcome, and (2) use RPA to define prognostic subsets with different survival potentials. Good performance status (PS), female sex, and age = 70 years were significant independent predictors in a Cox model applied to the entire population. In a second Cox model for patients with good PS enrolled on recent studies, hemoglobin level = 11.Og/dL, normal lactate dehydrogenase (LDH), normal calcium, and a smgle metastatic site were sigmficant favorable factors. The use of of improved outcome cisplalin was an additional independent predictor in both Cox models after adjustments for year of accrual and all prognostic variables. The favorable effect of cisplatin was observed in each of six RPA-derived subgroups from the entire population. A second RPA of 904 patients from recent trials (nearly all received cisplatin-based therapy) resulted in three distinct prognostic subsets based on PS,age, hemoglobin, and LDH: = I -year survivals were 27%. 16%, and 6% (P < .OOOl).The best survival occurred for patients with a good PS who had a hemoglobin level = 11 g/dL and who were older than 47 years. This analysts suggests that although several factors were Independent variables in the Cox models, three important prognostic subgroups were easily defined through RPA. Together with other analyses, our results suggest the need to modify the stage IV category m NSCLC. Correlation of modal chromosome number of cultured non-small cell lung carcinomas with DNA index of solid tumor tissue Siegfried JM. Ellison DJ, Resau JH, Miura I, Testa JR. Department of Pharmacology,

University

of Pirrsbwgh.

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Cancer Res 199 I;5 1~3267-73. The modal chromosome number of 13 non-small cell lung carcinomas placed into culture was compared to the DNA index of the tumor tissue as measured by flow cytometry in order to determine whether cytogenetic results from such cultures are representative of the original solid tumor. The modal chromosome number observed in culture, which ranged from 45-146, fell within the range of aneuploidy predicted from the DNA content of the original tissue in all 13 cases. In 7 cases, flow cytometry results showed that the aneuploid G,/G, popttlalion of the tumor tissue (DNA index of 1.5 or higher) represented 1I76% of the cells present, while diploid cells (presumably normal tissue) made up the remainder of the population. In these 7 cases, modal chromosomes numbers of 61-92 were found in tumor cells cultured from the tissue. In 3 cases, only a diploid or neardiploid population was found by flow cytometry, consistent with the near-diploid modal chromosome number of cultured cells observed (45-55). In 3 cases, the aneuploid Cl/G0 population (DNA index of 1.5, 1.6, and 3.2) of the original tissue represented only a small fraction of the solid tumor (I5% of cells). Modal chromosome number found in cells cultured from these 3 cases was 64-69, 62-68, and 136-146, which is in close agreement with the aneuploid peak observed in the tissue. Histological Tower,

Pittsburgh,

PA 15261.

analysis of the tumor tissue in two of the latter cases showed large numbers of infiltrating lymphocytes and/or stromal tissue which could have dominated the measurement by flow cytometry. In the third case, tumor cells made up at least 75% of the spectmen examined, implying that part of the population in the “diploid” peak contained tumor cells in this specimen. Only the aneuploid population was detected in culture of this tumor. Agreement between flow cytometry andcytogenetics was found in cases in which metaphase spreads were obtained within a few days of culture as well as after several months. These results indicate that highly aneuploid populations are found m many, but not all, nonsmall cell lung tumors. Although in some cases multiple populations may exist in the tumor which do not all proliferate in vitro. tumor cells which are found in culture of solid lung carcinomas are representative of the original tumor. Flow cytometry findings in the solid tumors confirmed the findingsofaneuploidy observed by cytogenetic analysis. Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients Ehington GM, Murray NMF, Spiro SG, Newsom-Davis J. Deparnenr of Clinical Neurology, Radcliffe Infirmary. Woodsrock Road, Oxford OX2 6HE. J Neural Neurostug. Psychiatry 1991;54:764-7. One hundred and fifty patients presenting with small cell lung cancer (SCLC) to chest physicians, were assessed neurologically. Neummttscular or autonomic deficits were common and occurred in up to 44% of cases. Weakness, dry mouth, and weight loss were not mutually independent and may represent the syndrome formerly described as carcinomalous neuromyopathy. By contrast, undoubted paraneoplaslic syndromes were much less commonly detected. Two patients had the Lambert-Eaton myasthenic syndrome (LEMS) and one had subacute sensory neuropathy (SSN). In these patients, neurological symptoms antedated other manifestations of cancer, by between six and 17 months. The 95% confidence Interval for the prevalence of LEMS or SSN among SCLC patients was O-4%, consistent with the results of previous retrospective or smaller studies: summing these, the overall prevalence of LEMS among SCLC patients is close to 3%, which tmpliesabout250newcasesperannum in Englandand Wales. IfLEMS and SSN are the least uncommon neurological paraneoplastic syndromes in SCLC patients, this may reflect the accessibility of motor nerve terminals and dorsal root ganglia to cross-reactive anti-lumour cell antibodies. Quality of life in lung cancer Geddes DM. Royal Bromplon and National Heart Hospital. Sydney Street, London SW3 6NP. Respir Med 1991;85:SuppI 8:7-l 1. The prognosis of a patient with lung cancer is poor and the quality is at least as important as the quantity of remaining life. Quality of life is a useful concept which is almost impossible to define but there are a number of important factors which contribute to it. Culture, religion, previous experience and the point of view of the individual all contribute to which of these factors are considered most important. Any quality of life assessment will, therefore, only apply to a defined community. The measurement of quality of life in cancer trials should concentrate on a few important categories such as physical symptoms, psychology and social factors and should be simple rather than conprehensive. In addition, a few frequent measures are better than an occasIonal comprehensive survey and ideally, both approaches should be combined and compared. Such measurements are most useful for comparative trials rather than for making an overall quality of life estimate. Finally, for routine clinical use outside clinical trials the quality of life index or the Kamofsky scale is recommended. HLA antigens and bronchogenic carcinoma in the Greek population Toumbis M,Z.ervas J, Anagnostopoulou 0, Konstantopoulos K. Krimbeni G, Kotsovoulou V et al. Second Deparrmenr of Chesr Medicine. Athens

Hospiral

Athens.

Acta Oncol 1991;30:575-8.

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Diseases,

152

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GR-11527

130 The distribution of HLA antigens was studied in 85 Greek patients with bronchogenic carcinoma. Fifty-seven specific HLA antisera were used to determine 27 HLA-A and B antigens, with the two-stage standard NIH microlymphocytotoxicity assay. The results were compared with those in a conuol group, consisting of 400 healthy individuals. In the whole group of patients there was a significantly higher frequency of HLA-AW19 and HLA-A29 (p < 0.003 and p < 0.006 respectively) and a lower frequency of HLA-A2 and HLA-A3 (p < 0.014 and p < 0.006 respectively) than in the control population. In patients with squamous cell carcinoma there was a significantly higher frequency of HLA-AW 19 and lower frequency of HLA-A2 (p < 0.02 and p < 0.05 respectively). In small cell carcinoma patients there was a significantly lower frequency of HLA-A3 (p c 0.04) than among the controls. In patients with adenocarcinoma no significant change of HLA antigen frequencies was observed when compared to the controls. Increased erytbrocyte magnesium levels iu small cell carcinoma of the lung. A relatiousbip with tumor growth? SaWri S, Nielsen I, Tassinari D, Trevisani L, Abbasciano V. II Divisione Medica, Dipartimento di Medicine Generale, Arcispedale S. Anna. Corso Giovecco 203,441OO Ferraro. Lung Cancer (The Netherlands) 1991;7:385-7. The requirement for magnesium (Mg) increases in rat erytbrozytes during tumor growth. Erythrocyte Mg (EMg) content was measured in 28 patients with small cell lung cancer and in 32 with epidermoid lung cancer by atomic absorption spectrophotometry, and compared with 40 healthy controls. EMg in small cell carcinoma was significantly higher than in epidermoid carcinoma (P
with invasion and obstruction of the left main bronchus after right sleeve pneumonectomy. The result was satisfactory not only for preventing asphyxia, but also for maintaining the patency of the airway after extubation of the endotracheal tube. Repeat mediitinoscopy iu the assessment of uew and recurrent lung neoplasm Meersschaut D, Vermassen F, De IaRiviere AB, Knaepen PJ. Van Den Bosch JM, Vanderschueren R. St. Anronins Hospital, t’ostbtu 2500, 3430 EM Nieuwegein. Ann Thorac Surg 1992;53: 120-2. From 1976 to 1990, 140 patients (mean age, 66 years; 91% male) underwent repeat mediastinoscopy as a routine staging procedure. The mean intervalbetweenfustandsecondmediastinoscopy was56months. Owing to adhesions, 26 repeat mediastinoscopies (18%) were considered incomplete. There was no mortality, and 10 complications did not require interventional therapy. The results were positive in 2Opatients thus avoiding an unnecessary thoracotomy. In 7 patients with negative findings, positive lymph nodes were found at thoracotomy or by tmnscarinal puncture biopsy. The sensitivity of repeatmediastinoscopy in this series is 74% and the accuracy 94%. We consider repeat mediastinoscopy a safe and reliable preoperative staging procedure in new or recurrent lung cancer. intrapleural therapy for malignant pleural effusions: A randomized comparison of bleomycin and tetracycline Ruckdeschel JC, Moores D, Lee JY, Einhom LH, Mandelbaum I, Koeller J et al. Albany Medical College, Albany,NY. Chest 199l;loO: 1528 35. Between December 1985 and August 1988, there were 115 patients at 13 centers who were entered on a randomized comparison of tetracycline and bleomycin for treatment of malignant pleural effusions. Fifteen patients were not treated, primarily due to rapid pmgression of systemic cancer. Fifteen patients entered on a high-dose regimen of bleomycin (120 units) were excluded from this analysis (following early closure of that arm), leaving 85 patients randomized to low-dose bleomycin (60 units; 44 patients) or tetracycline (1 g; 41 patients). Patients were required to have a cytologically positive pleural effusion, good performance status (0, 1, or 2). lung reexpansion following tube tboracostomy with drainage rates of 100 ml/24 or less, no prior intrapleural therapy, no prior systemic bleomycin therapy, no chest irradiation, and no recent (four weeks) change in systemic therapy. A total of 11 patients (five with bleomycin and six with tetracycline) were not evaluable due to technical problems with tube drainage (one), loss to follow-up (two), sudden death due to pulmonary embolus (one), and rapid progression of systemic disease (seven). There were no clinically significant differences in demographic factors, primary site, performance status, or presence of metastases other than pleural effusion. Overall survival did not differ between the two groups. Median time to recurrence or progression of the effusion was 32 days for tetracycbnetreated patients and at least 46 days for bleomycin-treated patients (p = 0.037). Therecurrencerate within 30 days of instillation was 36percent (10/28) with bleomycin and 67 percent (18/27) with tetracycline @ = 0.023) (not all patients were restudied in the first 30 days). By 90 days the corresponding recurrence rates were 30 percent (1 l/37) for blwmytin and 53 percent (19/36) for tetracycline (p = 0.047). Toxicity was similar between groups. Establishment of tumor cell lines as an independent prognostic factor for survival time in patients with small-cell lung cancer Masuda N, Fukuoka M, Matsui K, Kusunoki Y. Kudoh S, Negom S et al. Department of Internal Medicine, Osaka Prefectural Habikino Hospital, 3-7- 1 Habikino. Habikino Osaka 583. J Natl Cancer Inst 1991;83:1743-8. We studied tumor samples from 39 patients, who entered our study from January 1989 to May 1990, to assess whether the ability to establish a continually growing tumor cell line from fresh tumor specimens can be associated with decreased survival times in patients