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Prognostic factors in resected stages I and II adenocarcinoma of the lung. A multivariate regression analysis of 137 consecutive patients
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lung cancer associated with parancoplastic sensory ncuropathy, encephalomyehtis, or both. Using the avidm-biotin immunoperoxidase method and a highly sensttive quantttative Western blot analysis, the ant]-Hu antlbody was not dctccted in the 50 normal human scra. Seven of the 44 patients wth small cell lung cancer but no paraneoplastic syndrome had detectable levels (average titer, 76 U/ml) of anti-Hu antibody on Westcm blot. These levels are significantly lower than the avcragc titer of the 25 patients who had small cell lung cancer and paraneoplastic sensory neuropathy or cncephalomyclitis (average titer, 4,592 U/ml). In thegroup with n”npxancoplasticsmallccll lungcancer (low anti-Ha titer) there was a predominance of women (5 women: 2 men), and all patients had ‘hmltcd’ disease when diagnosed. In the armbody-ncgauvegroup thescxratlowas lhwomen to21 menand51% ofthepatients had ‘cxtensivc’disease. Noneofthe7patienlr withalowtttcram-Huantibodydevelopeda parancoplastic syndrome by the time of writmg. The anti-Hu armbody appears, when present, to be a good marker for small cell lung cancer and, when present at high trter, for small ccl1 lung cancer associated with a parancoplasuc syndrome. Value of neuron specific enolase in early detection of relapse in small cell lung carcinoma Van ZandwJk N, Jassem E, Bonfrer JMG, Van Tinteren H. The Vether1and.sCancer In.wum, Ple.\manlaan 121, 1066 CX Amlerdam. Ear J Cancer 1990;26:373-6. Serum levels of NSE were monaored in 20 SCLC patients who completely responded to combmation chemotherapy. An elevatton of NSE was observed m five of nine patients with recurrent disease, but predated a relapse in only one. No elevation in NSE level was noted in nme patients who remained in complete remission. The addition of serial assays of LDH to NSE monitoring did not result in any gain in early warning of relapse. This study suggests that the value of serial NSE mcasurcments for predicting a relapse of disease is limited. Prognostic factors in resected stages I and II adenocarcinoma of the lung. A multivariate regression analysis of 137 consecutive patients Sorensen JB, Badsberg JH. Depmment of Oncology ,Finsen fnsritulei R~@~sprmlef, Y Blegdmwe/, DK-2100 Copentqen. J Thorax Cardiovast Surg 1990;99:218-26. I The prognosuc factors for survival after radical resection of stages and II adenocarcinomaof the lung were investigated m 137 consecutive patients. Seventeen variables were investigated by use of Cox’s multivariate regression model. Factors predicting a poor prognosis were low status of Karnofskyperlbrmance, histologic subtype of solid carcinoma with formation of mucus, and T2 and NI disease. The staging according to American Joint Committee on Cancer Staging did not provide significant information on surival when the variables describing T and N status were included in the Cox model. The new intemauonal staging system carried prognostic information because the new stages I and II are Identical with the. NO and Nl groups. Groupings of patients according to the prognostic variables defined in this study allow for more detailed prediction of survival than can be achieved solely by T and N groupings. Tbe prognostic information may be used in the design and interpretation of clinical trials and in the selection of patients who might bc considered potential candidates for studies of adjuvant treatment.
The accuracy of clinical evaluative intrathoracic staging in lung cancer as assessed by postsurgical pathologic staging Fcmando HC, Goldstraw P. Brompton Hospital, Fulham Road, London. SW3 6HP. Cancer 1990;65:2503-6. The records of 103 patients undergoing thoracotomy for carcinoma oi the lung between 1985 and 1988 were reviewed. All patients underwent a uniform staging protocol rn the construction of a clmical evaluative stage (cTNM). Usmg information obtained at thoracotomy supplemented by pathologlcal examination a more accurate stage was constructed (pTNM). We haveevaluated theaccuracy ofcTNM stagmg usmg the pTNM staging constructed following thoracotomy. In 46.6% patients cTN and pTN concurred. When comparing T subsets alone 81.6% pauentsremainedunchanged. Oncomparingnodal stagingalone 55.3% patients remained unchanged. Pre-operative evaluation underestimated far more commonly than it overestimated. Mediastinal node
involvement was not overestimated smcc any suggestion of such involvement was confirmed by mediastmal exploration. Constructton of a cTNM stage remains a crude evaluation, but we remain convmced that the major aspect of pre-operative evaluation IS the exclwon of gross mcdiastinal gland involvement by mediastmal exploration. Tracheal mucus rheology in patients undergoing diagnostic bronchoscopy. Interrelations with smoking and cancer Zayas JG, Man GCW, King M. Univerwy ofAlberla. Edmonlon. Ah T6G 2C2. Am Rev Respir Dls 1990;141:1107-13. WC examined the drfferences in tracheal mucus rheology between nonsmokers and smokers, and between smokers with and without lung cancer. Mucus was collected from patients undergoing diagnostic bronchoscopy wthout atropinc by holding a cytology brush m contact with the tracheal mucosa ior IO to 15 s. Samples were obtained from 43 patients 24 to 79 yr of age: rune nonsmokers, IX current smokers, and 16 exsmokers (> 6 months); 12 patients (nine smokers, three cxsmokers) had lung cancer. Pulmonary function testing showed that the nonsmoker patients had sigmficant restrictwe lung dwasc, and the patients withcanccrhad slgnificantirreverslbleaxwayobstructlon. The viscoelastic properties of the mucus samples were dctcrmmed by magnetic microrheometry. Two parameters are reported: G* (modulus of rtgldity) and tan a(loss tangent), each measured at 1and 100rad/s. G* is an index of overall deformabdity (elastic and viscous), and tan”. is the ratio of viscous to elastic deformabihty. For nonsmoker pauenw the viscoelastic parameters were virtually identical to those found previously for normal volunteers. For smokers without cancer, the mucus had a lower value of tan CYat I rad/s and therefore was predicted to be more easily transportable by cdiary action; for exsmokers without cancer, ciliary transportabdity as calculated from wscoelasticity was even higher because of both low tana and low G*. Mucus from patients with cancer was not sigmficantly different from that of nonsmokers; however, the mucus was predicted to be less easdy clearable by cthary action than was that from smokers and exsmokers without cancer, mainly because of a higher tana at 1 rad/s. This rheologlc difference perststed even when the patients were matched for degree of obstruction, comparmg the cancer group with the more obstructed smokers wthout cancer. In all smokers, with or without cancer, the mucus was predicted to be less easdy clearable by coughmg. This latter abnormalIty increased with themagnitudeoftobaccoconsumptlon. butlt wasnot accentuated in those with cancer. Our findings arc conswent with the hypothesis that long-term impairment of mucus clearance could represent a risk factor for the development of lung cancer m smokers. Comparison of high molecular weight alkaline phosphatase and glycylprolinedipeptidylaminopeptidasefor thedetection ofhepatic metastasis by liver function tests in lung cancer patients Nishio H, Sakuma T, Nakamura S-l, Horai T, Ikcgami H, Matsuda M. Department of Internal Medicine, Osaka Second Poln Ilosp~al, Osaka. Lung Cancer (Japan) 1990;30:51-7. High molecular weight alkaline phosphatasc (HMW-ALP) and glyclyproline dipeptidyl aminopcptidasc (GPDA) acuvitles were measured in the sera of I1 1 patients with lung cancer to determine theu diagnostic values in the detection of hcpauc metastasis. HMWALP was positive in 15 of 21 patients with hepatlc metastasis and m 6 of 90 patients without hepatic metastasis. Thus the sensitivity, specificity and accuracyofthislestwerc71.4%,93.3%and89.2~,respectivcly. It was noted that the activity of HMW-ALP tended to increase as the hepadc metastasis became more serious in extent. On the other hand. the scnsltwity, spwficlty and accuracy of the test with GPDA measurement for hepatic metastasis were 19-O%, X3.3% and 71.2%. respectively. It is concluded that HMW-ALP IS a useful marker for hepatlc mctastasls in patgcnts wth lungcanccr. Incontrast,GPDA 1s Inadequate as a diagnostx tool for the detccuon of hcpatic mctas&w+. Detection of tumor necrosis factoricachectin in pleural effusion of patients with lung cancer Ishii Y, Uchiyama Y, Hasegawa S et al. Deporrmnt ofAnatomy, Institute of Basic Medrcal Scrences, University of Tsukubo. Tsukubo. Ibaraki 305. Clin Exp Immunol 1990;80:350-3.
lung cancer associated with parancoplastic sensory ncuropathy, encephalomyehtis, or both. Using the avidm-biotin immunoperoxidase method and a highly sensttive quantttative Western blot analysis, the ant]-Hu antlbody was not dctccted in the 50 normal human scra. Seven of the 44 patients wth small cell lung cancer but no paraneoplastic syndrome had detectable levels (average titer, 76 U/ml) of anti-Hu antibody on Westcm blot. These levels are significantly lower than the avcragc titer of the 25 patients who had small cell lung cancer and paraneoplastic sensory neuropathy or cncephalomyclitis (average titer, 4,592 U/ml). In thegroup with n”npxancoplasticsmallccll lungcancer (low anti-Ha titer) there was a predominance of women (5 women: 2 men), and all patients had ‘hmltcd’ disease when diagnosed. In the armbody-ncgauvegroup thescxratlowas lhwomen to21 menand51% ofthepatients had ‘cxtensivc’disease. Noneofthe7patienlr withalowtttcram-Huantibodydevelopeda parancoplastic syndrome by the time of writmg. The anti-Hu armbody appears, when present, to be a good marker for small cell lung cancer and, when present at high trter, for small ccl1 lung cancer associated with a parancoplasuc syndrome. Value of neuron specific enolase in early detection of relapse in small cell lung carcinoma Van ZandwJk N, Jassem E, Bonfrer JMG, Van Tinteren H. The Vether1and.sCancer In.wum, Ple.\manlaan 121, 1066 CX Amlerdam. Ear J Cancer 1990;26:373-6. Serum levels of NSE were monaored in 20 SCLC patients who completely responded to combmation chemotherapy. An elevatton of NSE was observed m five of nine patients with recurrent disease, but predated a relapse in only one. No elevation in NSE level was noted in nme patients who remained in complete remission. The addition of serial assays of LDH to NSE monitoring did not result in any gain in early warning of relapse. This study suggests that the value of serial NSE mcasurcments for predicting a relapse of disease is limited. Prognostic factors in resected stages I and II adenocarcinoma of the lung. A multivariate regression analysis of 137 consecutive patients Sorensen JB, Badsberg JH. Depmment of Oncology ,Finsen fnsritulei R~@~sprmlef, Y Blegdmwe/, DK-2100 Copentqen. J Thorax Cardiovast Surg 1990;99:218-26. I The prognosuc factors for survival after radical resection of stages and II adenocarcinomaof the lung were investigated m 137 consecutive patients. Seventeen variables were investigated by use of Cox’s multivariate regression model. Factors predicting a poor prognosis were low status of Karnofskyperlbrmance, histologic subtype of solid carcinoma with formation of mucus, and T2 and NI disease. The staging according to American Joint Committee on Cancer Staging did not provide significant information on surival when the variables describing T and N status were included in the Cox model. The new intemauonal staging system carried prognostic information because the new stages I and II are Identical with the. NO and Nl groups. Groupings of patients according to the prognostic variables defined in this study allow for more detailed prediction of survival than can be achieved solely by T and N groupings. Tbe prognostic information may be used in the design and interpretation of clinical trials and in the selection of patients who might bc considered potential candidates for studies of adjuvant treatment.
The accuracy of clinical evaluative intrathoracic staging in lung cancer as assessed by postsurgical pathologic staging Fcmando HC, Goldstraw P. Brompton Hospital, Fulham Road, London. SW3 6HP. Cancer 1990;65:2503-6. The records of 103 patients undergoing thoracotomy for carcinoma oi the lung between 1985 and 1988 were reviewed. All patients underwent a uniform staging protocol rn the construction of a clmical evaluative stage (cTNM). Usmg information obtained at thoracotomy supplemented by pathologlcal examination a more accurate stage was constructed (pTNM). We haveevaluated theaccuracy ofcTNM stagmg usmg the pTNM staging constructed following thoracotomy. In 46.6% patients cTN and pTN concurred. When comparing T subsets alone 81.6% pauentsremainedunchanged. Oncomparingnodal stagingalone 55.3% patients remained unchanged. Pre-operative evaluation underestimated far more commonly than it overestimated. Mediastinal node
involvement was not overestimated smcc any suggestion of such involvement was confirmed by mediastmal exploration. Constructton of a cTNM stage remains a crude evaluation, but we remain convmced that the major aspect of pre-operative evaluation IS the exclwon of gross mcdiastinal gland involvement by mediastmal exploration. Tracheal mucus rheology in patients undergoing diagnostic bronchoscopy. Interrelations with smoking and cancer Zayas JG, Man GCW, King M. Univerwy ofAlberla. Edmonlon. Ah T6G 2C2. Am Rev Respir Dls 1990;141:1107-13. WC examined the drfferences in tracheal mucus rheology between nonsmokers and smokers, and between smokers with and without lung cancer. Mucus was collected from patients undergoing diagnostic bronchoscopy wthout atropinc by holding a cytology brush m contact with the tracheal mucosa ior IO to 15 s. Samples were obtained from 43 patients 24 to 79 yr of age: rune nonsmokers, IX current smokers, and 16 exsmokers (> 6 months); 12 patients (nine smokers, three cxsmokers) had lung cancer. Pulmonary function testing showed that the nonsmoker patients had sigmficant restrictwe lung dwasc, and the patients withcanccrhad slgnificantirreverslbleaxwayobstructlon. The viscoelastic properties of the mucus samples were dctcrmmed by magnetic microrheometry. Two parameters are reported: G* (modulus of rtgldity) and tan a(loss tangent), each measured at 1and 100rad/s. G* is an index of overall deformabdity (elastic and viscous), and tan”. is the ratio of viscous to elastic deformabihty. For nonsmoker pauenw the viscoelastic parameters were virtually identical to those found previously for normal volunteers. For smokers without cancer, the mucus had a lower value of tan CYat I rad/s and therefore was predicted to be more easily transportable by cdiary action; for exsmokers without cancer, ciliary transportabdity as calculated from wscoelasticity was even higher because of both low tana and low G*. Mucus from patients with cancer was not sigmficantly different from that of nonsmokers; however, the mucus was predicted to be less easdy clearable by cthary action than was that from smokers and exsmokers without cancer, mainly because of a higher tana at 1 rad/s. This rheologlc difference perststed even when the patients were matched for degree of obstruction, comparmg the cancer group with the more obstructed smokers wthout cancer. In all smokers, with or without cancer, the mucus was predicted to be less easdy clearable by coughmg. This latter abnormalIty increased with themagnitudeoftobaccoconsumptlon. butlt wasnot accentuated in those with cancer. Our findings arc conswent with the hypothesis that long-term impairment of mucus clearance could represent a risk factor for the development of lung cancer m smokers. Comparison of high molecular weight alkaline phosphatase and glycylprolinedipeptidylaminopeptidasefor thedetection ofhepatic metastasis by liver function tests in lung cancer patients Nishio H, Sakuma T, Nakamura S-l, Horai T, Ikcgami H, Matsuda M. Department of Internal Medicine, Osaka Second Poln Ilosp~al, Osaka. Lung Cancer (Japan) 1990;30:51-7. High molecular weight alkaline phosphatasc (HMW-ALP) and glyclyproline dipeptidyl aminopcptidasc (GPDA) acuvitles were measured in the sera of I1 1 patients with lung cancer to determine theu diagnostic values in the detection of hcpauc metastasis. HMWALP was positive in 15 of 21 patients with hepatlc metastasis and m 6 of 90 patients without hepatic metastasis. Thus the sensitivity, specificity and accuracyofthislestwerc71.4%,93.3%and89.2~,respectivcly. It was noted that the activity of HMW-ALP tended to increase as the hepadc metastasis became more serious in extent. On the other hand. the scnsltwity, spwficlty and accuracy of the test with GPDA measurement for hepatic metastasis were 19-O%, X3.3% and 71.2%. respectively. It is concluded that HMW-ALP IS a useful marker for hepatlc mctastasls in patgcnts wth lungcanccr. Incontrast,GPDA 1s Inadequate as a diagnostx tool for the detccuon of hcpatic mctas&w+. Detection of tumor necrosis factoricachectin in pleural effusion of patients with lung cancer Ishii Y, Uchiyama Y, Hasegawa S et al. Deporrmnt ofAnatomy, Institute of Basic Medrcal Scrences, University of Tsukubo. Tsukubo. Ibaraki 305. Clin Exp Immunol 1990;80:350-3.