Prognostic factors in medullary thyroid carcinomas. Survival in relation to age, sex, stage, histology, immunocytochemistry, and DNA content

Patients with medullary thyroid carcinomas (MTC) were analyzed according to age, sex, and tumor stage. In addition, the MTC were screened for the predominant histologic pattern, immunocytochemical spectrum (60 tumors), and DNA content (DNA cytophotometry and DNA flow cytometry, 25 tumors). These findings were correlated with follow-up data available for 45 of these patients. Forty-eight percent of the tumors revealed a polygonal cell pattern, whereas 22% showed spindle-cell predominance. All tumors contained cytokeratin, chromogranin A, and calcitonin (CT). Calcitonin gene-related peptide (CGRP) was present in 92%, carcinoembryonic antigen (CEA) in 77%, neuron-specific enolase (NSE) in 75%, and vimentin in 53% of cases. Positivity for neurotensin, somatostatin, neurofilaments, bombesin, and alpha human chorionic gonadotropin (a-hCG) and serotonin ranged between 3% and 27%. All MTC were negative for substance P, adrenocorticotropic hormone (ACTH), thyroglobulin (TG), or S-100 protein. Local recurrences and regional lymph node metastases revealed identical staining patterns as the primaries. Prognosis of MTC was found not to be related to histologic features (dominant architectural pattern, cellular shape, presence of amyloid deposits) or immunocytochemical pattern. Instead, survival was significantly correlated to age, sex, and stage of disease. The best prognosis was seen in women younger than 40 years and revealing an early stage of disease. DNA measurements added valuable information in assessing the prognosis of MTC.     

Prognosis of non-small cell lung cancer patients with positive pleural lavage cytology after a thoracotomy: results of the survey conducted by the Japan Clinical Oncology Group

OBJECTIVE: The purpose of this study was to clarify the prognosis of non-small cell lung cancer patients without pleural effusion whose intrapleural cancer cells were detected by a cytologic examination of pleural lavage fluid obtained immediately after a thoracotomy. METHOD: A questionnaire survey on the survival of the patients with positive pleural lavage cytology from January 1985 to December 1994 was performed by the Japan Clinical Oncology Group. RESULTS: According to the data collected from 15 institutions, 1890 non-small cell lung cancer patients without pleural effusion underwent pleural lavage cytology immediately after thoracotomy and 142 (7.8%) of them were found to have intrapleural cancer cells detected by the cytological analysis. The information of survival on 113 patients was available. This comprised of 64 males and 49 females with a mean age of 64.6 years. The predominant histologic type was adenocarcinoma (74%). Out of these 113 patients, 109 (97%) underwent a surgical resection. The 5-year survival rate was 30% in all patients, 49% in pathological stage I (n=35), 23% in stage II (n=20) and 26% in stage IIIA (n=34). CONCLUSION: Patients with a positive pleural lavage cytology in pathological stage I or II appear to have a poor 5-year survival rate.     

Incident lung cancer survival. Long-term follow-up of a population-based study in Italy

The long-term survival of an incident lung cancer population was evaluated in relation to clinical stage, treatment modalities and other prognostic factors. The survey was carried out among the residents in the Local Sanitary Unit of Saronno, a highly industrialized area of northern Italy, where all the lung cancer cases diagnosed during the years 1976-79 had been identified and clinically studied. The overall survival of the 222 cases included in the analysis was 32% at 1 year, 10% at 3 years and 5% at 5 years; median survival was 7 months. A significantly better prognosis was associated with surgical resection (32% at 5 years; median, 42 mo), clinical stage I (16% at 5 years; median, 15 mo), and squamous cell carcinoma (13% at 5 years; median, 11 mo). Other factors such as age, sex, social class or cancer symptoms did not affect survival when treatment was taken into account. Our data show that surgical resection is the major determinant of survival, and suggest that sub-optimal access to curative treatment, particularly in patients aged 60 to 75 with limited disease, might have compromised the overall survival.     

Distribution according to histologic type and outcome by gender and age group in Taiwanese patients with lung carcinoma

BACKGROUND: The results from previous studies suggested that the clinical characteristics and outcomes of patients with lung carcinoma vary between gender and age groups. The objective of the current study was to assess the trend in the evolution of the histologic types in Taiwan and to compare the outcomes of patients with lung carcinoma between different gender and age groups. METHODS: Patients with primary lung carcinoma were identified through the cancer registry system. Clinical records were reviewed and analyzed for age, gender, disease stage, histology, treatment modalities, and survival. A multivariate analysis using a Cox proportional hazards model was applied for gender, age (by decade), histologic type, disease stage, and treatment modality. RESULTS: Between 1991-1999, 2714 patients with histologically or cytologically proven lung carcinoma were included. Adenocarcinoma was the major cell type of lung carcinoma (52.5%), with a significant trend toward an increase in adenocarcinoma during the study period. A significantly high percentage of adenocarcinoma was demonstrated in female patients (73.5%), who also had better survival compared with male patients (P = 0.002), especially in the group age 50-69 years. Patients age < 40 years also had a poor prognosis, which was worse compared with the prognosis for patients age 40-59 years. patients who had adenocarcinoma had a better survival rate compared with patients who had other histologic types (relative risk, 0.78; 95% confidence interval, 0.69-0.87). CONCLUSIONS: Adenocarcinoma was predominant in female patients and emerged as a greater problem than other histologic types in Taiwan, potentially raising the importance of studies regarding the benefit of population diversity in new antitumor therapies, such as gefitinib. Female patients with lung carcinoma had a better prognosis than male patients in the group age 50-69 years, warranting further studies on potential prognostic factors associated with middle age, such as hormone status.     

Frequency and prognostic importance of pretreatment clinical characteristics in patients with advanced non-small-cell lung cancer treated with combination chemotherapy

To determine the frequency and prognostic importance of pretreatment clinical characteristics in patients currently undergoing treatment for stage III non-small-cell lung cancer (NSCLC), data were collected on 378 patients receiving high-dose (120 mg/m2) cisplatin plus vinca alkaloid combination chemotherapy regimens since 1978. Variables analyzed included age, sex, weight loss, performance status, histologic subtype, presence of extrathoracic metastases, number of metastatic organ sites, presence of liver, bone, or brain involvement, prior radiation or surgery, and serum lactate dehydrogenase (LDH). The effect of a major response to chemotherapy on survival was also investigated. Using multivariable analyses, the following were found to be associated with outcome: initial performance status, with patients having a performance status of 80% to 100% having an increased major objective response rate and survival; bone metastases, which were adversely predictive of response rate and survival; elevated serum LDH and male sex, both of which were associated with shortened survival and remission duration; and the presence of two or more extrathoracic metastatic organ sites, which was associated with shorter survival. When major objective response with chemotherapy was included in a conditional multivariable analysis, it was strongly associated with longer median survival. Information from this analysis may be useful when comparing the response data of completed studies in similar patients, in designing future trials, and in the selection of cisplatin plus vinca alkaloid therapy for individual patients with advanced NSCLC.     

巨块型肺癌的外科治疗及预后因素分析

目的探讨巨块型肺癌的外科治疗及影响预后的因素。方法回顾性分析上海市肺科医院1992年8月至2005年8月经手术治疗的137例巨块型肺癌患者的临床及病理资料,其中根治性手术122例,姑息性手术15例。122例根治性手术中,肺叶切除63例,全肺切除48例,其他手术方式11例。分别对患者性别、肿瘤大小、p-TNM分期、局部淋巴结N分期、原发肿瘤T分期、组织学类型、手术方式和手术性质等因素进行预后分析。Kaplan-Meier计算生存率,Log rank法进行生存率显著性检验,应用Cox比例风险回归模型进行单因素和多因素分析。结果全组1、3、5年生存率分别为76.0%、49.2%和40.1%。单因素分析显示,患者性别(P=0.001)、p-TNM分期(P=0.001)、N分期(P=0.042)、T分期(P=0.006)、手术性质(P=0.026)是影响患者预后的因素。多因素分析则显示,p-TNM分期(P=0.001)是影响患者预后的独立因素。结论p-TNM分期是影响巨块型肺癌患者预后的主要因素。对巨块型肺癌患者,应严格控制手术适应证的选择,争取根治性手术,以获得较高的生存率。     

Smoking history before surgery and prognosis in patients with stage IA non-small-cell lung cancer--a multicenter study

The prognosis of lung cancer patients with surgically resected non-small-cell lung cancer (NSCLC) can be predicted generally from age, sex, histologic type, stage at diagnosis, and additional treatment. Nine studies have reported that a history of smoking before diagnosis influences the prognosis of the disease in lung cancer patients. In this study, a total of 3082 patients who underwent surgery and were diagnosed with primary pathological stage IA NSCLC at 36 national hospitals from 1982 to 1997 were analyzed for the effect of smoking on survival. Smoking history and other factors influencing either the overall survival or the disease-specific survival rates of patients were estimated with the Cox proportional hazards model. Multivariate analysis demonstrated significant associations between overall survival and age (P < 0.0001), sex (P = 0.0002), and performance status (PS) (P < 0.0001). Disease-specific survival was associated with age (P = 0.0063), sex (0.00161), and PS (P = 0.0029). In males, disease-specific survival was associated with age (P = 0.0120), PS (P = 0.0022), and pack-years (number of cigarette packs per day, and years of smoking) (P = 0.0463). These results indicate that smoking history (pack-years) is important clinical prognostic factor in estimating disease-specific survival, in male patients with stage IA primary NSCLC that has been surgically resected.     

Histology-related variation in the treatment and survival of patients with lung carcinoma in Canada

OBJECTIVES: The aim of the study was to examine histologic differences in lung cancer treatment and survival, and to define recent survival trends in Ottawa, Canada. METHODS: From 1994 to 2000, 3,237 patients with invasive lung cancer were registered at the Ottawa Regional Cancer Centre (ORCC) and were followed up to 31 December 2001. Five-year relative survival rates (RSRs) and relative excess risks (RERs) of dying were calculated by stage and dominant initial treatment modalities for major cellular histologies using a relative survival model. RESULTS: The overall 5-year survival rate was 14%, and female patients had significantly better survival. Patients with stage I and II non-small cell lung cancer (NSCLC) who were treated by surgery alone were more likely to survive (5-year RSRs were 72 and 48%, respectively) than those who received other treatments. Patients with stage III NSCLC had a 5-year survival rate of 9% after chemotherapy plus radiotherapy, whereas stage IV patients who received only chemotherapy had better survival for up to 2 years than patients with other treatments. In cases of limited-stage small cell lung cancer (SCLC), survival was better for patients who received chemotherapy plus radiotherapy than for those who received only chemotherapy. CONCLUSIONS: The relatively superior survival of surgical patients with stage I NSCLC implies that a considerable number of patients have the potential to be treated successfully. The overall poor survival of lung cancer patients suggests a need for more national public health emphasis on lung cancer prevention, improved screening and early diagnosis, and better treatment.     

139例晚期非小细胞肺癌的生存分析

目的 探讨影响晚期非小细胞肺癌(NSCLC)预后的重要因素.方法 收集2003年1月至2004年9月139例晚期NSCLC患者临床资料,所有病例经细胞病理学或组织病理学确诊.分析性别、年龄、病理类型、临床分期和治疗方式对预后的影响,用乘积极限法计算生存率,用对数秩和检验(Log-rank)检验生存率差别,再用Cox多因素回归对预后因素进行分析.结果 本组晚期NSCLC总的中位生存期8个月,6个月生存率59.9%,12个月生存率35.8%,24个月生存率14.3%.治疗方式分为手术加化疗、化疗加放疗、单纯化疗和对症治疗4组,其24个月生存率分别为46.4%、32.2%、9.5%、3.0%,生存率差异有统计学意义(P＜0.05).结论 治疗方式是影响晚期NSCLC预后的重要因素.     

Computed tomography-diagnosed emphysema, not airway obstruction, is associated with the prognostic outcome of early-stage lung cancer.

PURPOSE: Because both emphysema and lung cancer can arise from biological damage caused by cigarette smoking, we investigated if the development of emphysema is associated with the clinical features of smoker's lung cancer. EXPERIMENTAL DESIGN: The subjects were a consecutive series of 100 smokers who underwent lobectomy with hilar and mediastinal dissection for clinical stage I non-small cell lung cancer. We studied the relationship between the presence or absence of emphysema at the onset of the lung cancer and clinicopathologic features. Emphysema was diagnosed by measuring the low-attenuation area using computed tomography densitometry. RESULTS: There were no differences in clinicopathologic variables, including the degree of smoking exposure between the patients with (n=58) and those without (n=42) emphysema, although male gender and airflow limitation were predominant in the patients with emphysema. The presence of emphysema, but neither male gender nor airflow limitation, adversely affected both overall and disease-specific survival. According to Cox regression analysis, emphysema was an independent prognosticator among age, gender, degree of smoking exposure, tumor size, nodal status, histologic subtype, histologic grade, and microvessel invasion. These results were stabilized by a bootstrap sampling model. CONCLUSIONS: Computed tomography-diagnosed emphysema, but not airway obstruction, is associated with poor prognosis in smokers with early-stage lung cancer. Thus, routine computed tomography densitometry in smokers with lung cancer should be mandatory.     

Ultrastructure of small-cell lung cancer

The research was concerned with electron microscopic analysis of 34 lung tumors histologically identified as small cell lung cancer. It was shown that ultrastructural studies can reliably identify histologic pattern of small cell lung cancer. In most cases, this type of cancer was represented by one of the following histologic patterns: epidermoid, glandular or neuroendocrine, the latter being predominant. An ultrastructural classification of small cell lung cancer is not advisable until a clinico-morphological analysis has been carried out.     

Surgery in the treatment of patients with small cell lung cancer

The data on surgical and combined treatment of 52 cases of small cell lung cancer are presented and the end results are evaluated. The findings on survival time make the case for surgery as a component of combined treatment of tumor. The best results were obtained in cases of stage I and II tumor, absence of metastases into intrathoracic lymph nodes, tumor invasion limited to bronchopulmonary lymph nodes or the root of the lung, intermediate cell pattern of small cell lung cancer and surgery followed by chemotherapy.     

Ⅲa期肺鳞癌生存因素分析

目的 分析Ⅲa期肺鳞癌的治疗模式.方法 回顾性分析102例Ⅲa期肺鳞癌患者的病历资料,并对临床信息及治疗情况等因素对患者生存的影响进行分析.结果 102例Ⅲa期肺鳞癌患者中,行根治性手术患者65例(63.7%),非根治性手术患者37例(36.3%).根治性手术组与非根治性手术组患者的中位OS分别为27.9个月和19.0个月,差异有统计学意义(P=0.005).单因素分析结果显示:N2淋巴结转移个数和N2淋巴结转移组数对行根治性手术的Ⅲa/N2期肺鳞癌患者的OS有影响(P<0.05),而N2淋巴结转移个数≥3个的患者术后死亡风险更高(RR=3.342).结论 对于Ⅲa期肺鳞癌患者,如果患者体力情况较好,建议行手术治疗.纵隔N2淋巴结转移个数是影响患者术后生存率的主要因素.     

Cervical stromal involvement can predict survival in advanced endometrial carcinoma: a review of 67 patients

Purpose

To assess clinical, surgical and pathologic variables in survival of advanced endometrial cancer.

Methods

Sixty-seven advanced-stage (stages III and IV according to FIGO 2009) endometrial cancer cases were evaluated retrospectively. The effects on survival of age, histologic subtype, stage, grade, myometrial invasion, optimal cytoreduction, parity and cervical involvement were analyzed.

Results

Cervical involvement (P = 0.033) and nulliparity (P = 0.042) were worsening features in terms of survival. In 56 cases (83.5%) optimal cytoreduction could be achieved and survival was significantly longer in this group than the group who were not optimally cytoreduced (mean 30.4 vs. 9.6 months) (P < 0.01). Depth of myometrial invasion, histologic type of tumor, stage, grade, and age younger or older than 60 years were not found to be related to survival. Neither adjuvant therapy type nor their combination were superior to each other for improving survival.

Conclusions

Cervical stromal involvement is a poor prognostic factor in cases of advanced endometrial carcinoma. Further studies are required to describe the effect of different surgical approaches such as radical hysterectomy on survival in the presence of cervical stromal invasion.     

Prognosis of non-surgically treated, clinical stage I lung cancer patients in Japan

OBJECTIVE: The optimal management of stage I lung cancer is surgical resection. However, some of these patients are not candidates for surgery because of several medical problems. We analyzed prognosis of non-surgically treated, clinical stage I lung cancer patients. METHODS AND RESULTS: There were 21211 lung cancer patients registered from 1982 to 1991 in the data-base of the Japanese National Chest Hospital Study Group for Lung Cancer, and the number of non-surgically treated, clinical stage I lung cancer patients during the 10 years was 802. The 5- and 10-year survival rates of the 799 patients, exclusive of two carcinoid tumors and one adenid cystic carcinoma which have good prognosis, were 16.6 and 7.4%. We analyzed the 799 patients according to several prognostic factors. Sex, T factor of the tumor, histology, performance status and the method in which lung cancer was detected were prognostic factors, but age and treatment method were not associated with prognosis. Forty-nine patients survived for 5 years or more without surgical resection, but the survival rate continued to decrease even after 5 years, and the 7- and 10- year survival rates were 34.4 and 18.1% in the 49 patients. CONCLUSIONS: It is a fact that there are long-term survivors in non-surgically treated, stage I lung cancer patients. However, the rate is low, and the survival curve continues to decrease even after 5 years. Long-term survivors might suggest the presence of a lung cancer in which the tumor growth is slow.     

Influence of sex on lung cancer histology, stage, and survival in a midwestern United States tumor registry

BACKGROUND: A study was performed to identify differences between men and women with regard to lung cancer type, stage at diagnosis, and survival in a single hospital system cancer registry. PATIENTS AND METHODS: A retrospective cohort study was designed based on a study population drawn from the lung cancer tumor registry at a single hospital system composed of 2 independent hospitals in the Midwestern United States. This database included all patients from 1996 to 2002 with known lung cancer or abnormal findings on chest radiography or computed tomography (N=2618). Patients with adenocarcinoma or squamous cell, small-cell, or large-cell carcinoma were included in the study. Data were collected on patient sex, age, cancer type, stage at diagnosis, and survival status. RESULTS: A total of 1216 men and 997 women met inclusion criteria for the study. There was no significant difference in age between sexes at diagnosis. Women were significantly more likely to have adenocarcinoma or small-cell carcinoma but less likely to have squamous cell carcinoma compared with men. There were no significant differences between sexes in the incidence of large-cell carcinoma. No significant differences were found between men and women in terms of cancer stage at diagnosis. There were significant differences in survival between the histologic types at years 3, 4, and 5. Only patients with stage I disease showed a difference between sexes and only for years 2, 3, 4, and 5. CONCLUSION: Overall differences in lung cancer histology and survival were found between men and women. Because a high mortality rate of lung cancer exists in both sexes, it is important to understand its occurrence and survival rates in both sexes.     

Clinical factors and prognosis in non-small cell lung cancer.

We evaluated the relationship of clinical characteristics and survival in 1,635 patients with non-small cell lung cancer (NSCLC) treated in Brazil. The following variables were included: sex, age, smoking, Karnofsky's performance status (PS), weight loss, symptoms at diagnosis (cough, dyspnea, hemoptysis, chest pain, wheezing, and hoarseness), presence of superior vena cava syndrome (SVCS), histologic type, TNM stage, and therapeutic modality (surgery, chemotherapy [CT] and radiotherapy [RT]). Multivariate prognostic models were obtained by Cox regression. Patients unsuitable for surgery or who had recidivant disease were elected to further RT and/or CT, and long-term results in this group were equivalent to those in the group treated only by surgery. A diagnosis of bronchioloalveolar carcinoma, small tumors, absence of hoarseness, treatment by surgery, and RT were independent factors related to good overall survival in stage I and II. Weight loss and clinical signs of SVCS were related to poor prognosis in stage III. PS, diagnosis of adenocarcinoma or undifferentiated carcinoma, absence of weight loss and dyspnea, NO or N1 disease, ability to receive RT, CT, and to perform some palliative surgical procedure were good prognostic factors in stage IV. Clinical features of patients with NSCLC at diagnosis offer additional information to estimate their prognosis.     

Prognosis of Stage II non-small cell lung cancer according to tumor and nodal status at diagnosis

PURPOSE: To evaluate the prognostic significance of tumor and node status among patients with Stage II non-small cell lung cancer using a population-based national database. METHODS: We identified all primary cases of Stage II non-small cell lung cancer diagnosed prior to autopsy from the Surveillance, Epidemiology and End Results (SEER) registry. Lung cancer-specific survival curves were obtained for the 5254 patients who had curative surgical resection, stratifying for tumor and node status (T1-2N1M0, T3N0M0). The 12.5-year Kaplan-Meier estimator of survival was used as a measure of lung cancer cure rate. The influence of gender, age, cell type, pathologic tumor status, nodal metastasis, surgical method, and post-operative radiation therapy were evaluated using Cox regression. RESULTS: Survival was better for T1N1 cases during the first 3--4 years after diagnosis. Five-year survival for T1N1 and T3N0 cases however, was not significantly different (46% versus 48%, p=0.4) and the cure rate was somewhat higher for T3N0 cases (33% versus to 27%, p=0.10). T2N1 cases had the worst overall survival. Multivariate analysis revealed that gender, age, tumor and nodal status, and histology were independent prognostic factors. CONCLUSIONS: Among Stage II cancers, T3N0 cases have the highest cure rate and an overall survival pattern that more closely resembles T1N1 tumors. Several clinico-pathologic characteristics are significantly associated with survival and may explain some of the heterogeneity in outcomes among Stage II patients. These results suggest that T3N0 cases may be better classified as Stage IIA disease.     

Ovarian cancer incidence and survival by histologic type in Osaka,Japan

The incidence of ovarian cancer among Japanese has increased since the 1970s. Histologic diversity is a characteristic of this cancer. However, there has been no population-based study made on the incidence and survival by histologic type. Osaka Cancer Registry's data was used for incidence and survival analyses of ovarian cancer by histologic type in this study. Seven thousand one hundred sixty-seven incident cases were registered during the period 1975 to 1998. According to the IARC's histologic classi-fication, types of ovarian cancer were classified into five categories. Survival analysis was restricted to the reported 2431 cases who lived in Osaka Prefecture (except for Osaka City) and were diagnosed in 1975–1994, since active follow-up data on vital status 5 years after the diagnosis were available. The age-standardized incidence rate of ovarian cancer increased from 4.0 to 5.4 per 100 000 women (standard: world population) in Osaka during the period 1975–1998. Carcinoma, the major histologic category, also increased (from 3.4 to 4.8 per 100 000 women), while sex cordstromal tumors decreased after 1980 and germ cell tumors remained stable. The 5-year relative survival was 36.4% for ovarian cancer patients diagnosed in 1975–1994. The survival for carcinoma was 38.3%, which was lower than that in sex cord-stromal tumors or germ cell tumors (55.3% and 58.6%, respectively). The increase in the incidence of ovarian cancer was caused by the increase in carcinoma. The relative 5-year survival of ovarian cancer improved over the period, but was different by histologic type. (Cancer Sci 2003; 94: 292–296)