Differences in epidemiology, histology, and survival between cigarette smokers and never-smokers who develop non-small cell lung cancer

BACKGROUND: The impact that smoking cigarettes has on the characteristics and survival of patients with non-small cell lung cancer (NSCLC) is disputed. METHODS: A retrospective cohort study using a prospective database of patients with NSCLC over a 6-year period. Clinical and histologic characteristics and survival rates were compared between smokers and never-smokers. RESULTS: There were 730 patients; 562 patients (77%) were smokers and 168 patients (23%) were never-smokers. The overall 5-year survival rate was greater in never-smokers (64%) compared to smokers (56%; p = 0.031). Never-smokers were more likely to be younger (p = 0.04), female (p = 0.01), symptomatic at the time of presentation (p < 0.001), have poorly differentiated tumors (p = 0.04), and have a higher maximum standardized uptake value (maxSUV) on positron emission tomography (PET) (p = 0.026) than smokers. The stage-specific 5-year survival rate was greater for never-smokers compared to smokers for stage I disease (62% vs 75%, respectively; p = 0.02), stage II disease (46% vs 53%, respectively; p = 0.09), and stage III disease (36% vs 41%, respectively; p = 0.13). The 5-year survival rate was significantly lower in patients who had a smoking history of > 20 pack-years. CONCLUSIONS: Never-smokers in whom NSCLC develops are more likely to be young, female, and have poorly differentiated tumors with higher maxSUV values on PET scans. Never-smokers with early-stage cancer have a significantly better survival rate than smokers. Patients with a smoking history of > or = 20 pack-years have worse survival. Thus, smoking not only causes lung cancer, but once NSCLC is diagnosed, the prognosis becomes worse. A biological, hormonal, and genetic explanation is currently lacking to explain these findings, and these data may help to improve treatment and surveillance.     

Socioeconomic factors and the presentation,management, and outcome of patients with differentiated thyroid carcinoma

To determine whether patients from disadvantaged socioeconomic groups present with more advanced thyroid carcinoma or experience differing management and clinical outcomes, we retrospectively reviewed the charts of 292 patients seen at MD Anderson Cancer Center and Ben Taub General Hospital between 1987 and 1994. At diagnosis, the mean age was 42 +/- 16 years, 78% of patients were female, 76% of patients were low risk (TNM stage I or II), and 22% high risk (stage III or IV). Neighborhood income (+/- standard error of the mean [SEM]) (1990 census data) was lower in the high-risk group compared with the low-risk group (US dollars 26200 +/- 1670 vs. US dollars 30900 +/- 870, p = 0.012). Men were more likely than women to present at an older age (47.5 +/- 16.7 vs. 40.2 +/- 16.0, p = 0.0014) and in the high-risk group (46% vs. 15%, p < 0.0001). No socioeconomic factor (ethnicity, marital status, occupation prestige, neighborhood income, insurance type) influenced initial diagnostic assessment. Similarly, no socioeconomic factor influenced initial disease management or the type of follow-up received over the 12-year period. Married patients had a lower 5-year recurrence rate than those unmarried (18% vs. 32%, p = 0.03); however, this did not affect overall or disease-specific survival. Similarly, ethnicity, marital status, occupation prestige, and insurance type did not influence overall or disease-specific survival. Although 10-year overall survival rates were lower in patients in the lowest income quartile (57% vs. 70% for upper, p = 0.0024) and in men compared with women (39% vs. 76%, p < 0.0001), gender alone influenced 10-year disease-specific survival (80% for men, 89% for women, p = 0.047). In summary, no socioeconomic factor appears to affect initial treatment or follow-up pattern in patients with differentiated thyroid cancer. Income and gender may affect stage at initial disease presentation and may be risk factors affecting eventual clinical outcomes.     

Surgical results and prognosis of patients with primary bronchogenic carcinoma aged less than 36 years

BACKGROUND AND OBJECTIVE: This study reports on the demographic features, clinico-pathological results and prognoses of patients aged less than 36 years diagnosed with non-small cell lung cancer (NSCLC). METHODS: This is an observational study of patients with primary NSCLC who had a surgical procedure at a tertiary thoracic surgery centre in Turkey. Data collected were age, gender, history of smoking, symptoms, postoperative histopathological diagnosis, stage, surgical procedure and survival. RESULTS: Of the 31 patients in the study, 27 were male (87%) and the median age was 32 years (10-35 years). Nineteen patients were smokers (61.2%). The most common presenting symptom was cough (n = 23, 67.7%). Histopathological diagnosis was squamous cell carcinoma (SCC, n = 17), adenocarcinoma (n = 12), lymphoepithelioma-like carcinoma (n = 1) and undifferentiated carcinoma (n = 1). Staging of the 17 patients with SCC (58.8%) was stage I and II (n = 10, 58%), and stage III (n = 7, 41%). Staging of the 13 patients with adenocarcinoma was stage IV (n = 2, 16%) and stage III patients (n = 8, 66%). Follow-up data were available on 22 patients (71%) and showed a median survival of 17.2 months. Two and 5-year survival rates were 54.5% and 45.5%, respectively. CONCLUSIONS: SCC comprised a relatively high proportion of NSCLC in these younger patients. Aggressive multimodality treatment may achieve satisfactory 2- and 5-year survival rates in young patients with NSCLC who usually present with advanced disease.     

Grading of tumor regression in non-small cell lung cancer : morphology and prognosis.

OBJECTIVE: Different types of multimodality therapy, including chemoradiotherapy and surgery, increasingly are being used for the treatment of patients with locally advanced non-small cell lung cancer (NSCLC; stages IIIA and IIIB). In this context, the applicability of a morphologic regression grading and its prognostic value were investigated. PATIENTS AND METHODS: In a multicenter phase II trial, 54 patients with locally advanced NSCLC received neoadjuvant bimodality treatment (ie, two cycles of ifosfamide, carboplatin, and etoposide, followed by twice-daily radiation up to 45 Gy with simultaneous administration of carboplatin and vindesine). Forty patients underwent resections. Using the corresponding resection specimens of the primary and regional lymph nodes, the following regression grading was established: grade I, no regression or only spontaneous tumor regression; grade II, morphologic evidence of therapy-induced tumor regression with at least 10% (grade IIa) or < 10% (grade IIb) vital tumor tissue; and grade III, complete tumor regression with no evidence of vital tumor tissue. Regression grading then was correlated with the survival time. RESULTS: Three tumors were classified as regression grade I, 10 were classified as regression grade IIa, 20 were classified as regression grade IIb, and 7 were classified as regression grade III. Patients with tumors of regression grades IIb or III showed significantly longer survival times than those with tumors of regression grades I or IIa (median survival time, 36 vs 14 months, respectively; 3-year survival rate, 52% vs 9%, respectively; p = 0.02). These survival times were also compared for patients who had undergone complete resection (median survival time, not reached vs 23 months, respectively; 3-year survival rate, 56% vs 11%, respectively; p = 0.03). The presurgical clinical response after patients had received neoadjuvant multimodality therapy had no predictive value in assessing the extent of therapy-induced tumor regression in the resection specimen. CONCLUSIONS: After neoadjuvant therapy of patients with NSCLC, the proposed tumor regression grading was of predictive value for long-term survival. Beyond the achievement of complete tumor resection (R0), a therapy-induced tumor regression of < 10% of vital tumor tissue is pivotal for superior long-term outcomes.     

Surgical strategy for non-small cell lung cancer in octogenarians

BACKGROUND AND OBJECTIVES: This study was conducted to determine the optimal surgical strategy for octogenarians with non-small cell lung cancer. METHODS: An observational study of 73 patients aged 80 years and over who underwent surgery for non-small cell lung cancer. Postoperative survival, mortality and morbidity were analysed. RESULTS: The age of the patients ranged from 80 to 89 with a mean of 83. Cancer types included adenocarcinoma (n = 46), squamous cell carcinoma (n = 22) and large cell carcinoma (n = 5). Lobectomy was performed in 47 patients and limited surgery in 26. The 5-year survival rate was 57.4% in pathological stage I, 88.9% in stage II and 18.2% in stage III, respectively. The 5-year survival rate of patients with stage I disease treated by limited resection (58.8%) was similar to that of patients treated by lobectomy (54.9%). Limited resection for stage IA showed slightly better survival than lobectomy (69.4% vs 48.2%, P = 0.10), however, lobectomy was superior to limited resection for stage IB (63.2% vs 16.7%, P = 0.07). Postoperative complications occurred in 27 patients (37%) and nine patients (12%) had multiple complications. There were three postoperative deaths (4.1%). CONCLUSION: The early detection of the disease, hopefully in stage IA enables surgical treatment by limited resection of patients aged 80 years and over. A favourable prognosis as well as low morbidity can be anticipated in such cases.     

HLA-A2 expression, stage, and survival in colorectal cancer

INTRODUCTION: Most cancer vaccination trials have been performed in human leukocyte antigen (HLA)-A2 positive populations. Some studies have used HLA-A2 negative patients as control group. However, HLA-type and HLA-expression can interact with tumor biology and possibly affect prognosis. HLA-A2 negative patients might constitute an inadequate control group. MATERIALS AND METHODS: Patients with colorectal cancer were serologically analyzed for HLA-A2 expression. Patients were evaluated for tumor stage, grading, tumor location. Overall survival (OAS) of HLA-A2 positive and HLA-A2 negative patients was compared. RESULTS: One hundred forty-four patients were evaluable (50% HLA-A2+). Median age was 62 years. UICC stage III or IV: 45.8%. Gender, location, and UICC stage were equally distributed between HLA-A2 subgroups. HLA-A2 positive patients more frequently had grade 3 histology (27.8% vs 13.9%) and chemotherapy (62.9% vs 45.6%). At a median follow-up of 75.8 months, median OAS for the entire study population was 123.3 months, 5-year OAS was 77.5%. No statistically significant difference in OAS was observed between HLA-A2 positive and negative patients (116.5 vs 157 months, 5-year-OAS 74.1 +/- 11.6% vs 81 +/- 11.6%, p = 0.46). Expectedly, patients with UICC stage I and II disease lived significantly longer than patients with stage III and IV (5-year OAS 94.3% vs 53.4%; p < 0.001). A significantly superior OAS was also found for women, independent of stage or HLA status. CONCLUSION: HLA-A2 positive patients exhibit poorer tumor differentiation. This might account for a non-significant difference in OAS. The use of HLA-A2 negative patients as control cohort in CRC vaccinations would rather underestimate potential treatment-related survival effects. Therefore, we suggest they constitute a valid auxiliary control group.     

Combined modality treatment of non-small-cell lung cancer

Among all nonmetastatic non-small-cell lung cancer (NSCLC) patients, the best survival rates are observed in patients who undergo surgery. Nevertheless, 5-year survival rates vary between 20% and 60% depending on the stage of the disease. Several combined modality treatments have been investigated to improve outcome in localized NSCLC. These include local treatment, systemic before local treatment, concomitant systemic and local treatments, and systemic after local treatment. Preoperative irradiation was shown to be of no benefit on local recurrence rates or overall survival. Even doses of radiation >/=40 grays (Gy) were associated with lower survival rates. Postoperative irradiation did not influence survival in stage III disease and seemed to be deleterious in stages I and II disease. Modern radiotherapy techniques might be of interest in this setting but have been insufficiently tested. The early phase III studies of preoperative chemotherapy versus primary surgery in stage III NSCLC showed a tremendous difference in favor of chemotherapy. A larger study did not confirm these results but suggested that preoperative chemotherapy might have a greater effect in stages I and II of the disease. In locally advanced disease, chemotherapy followed by radiotherapy was shown to increase survival when compared with radiotherapy alone. Studies comparing concurrent chemoradiation with radiotherapy only were in favor of the concomitant schedule, which improved local control. Promising results have been reported with chemoradiation followed by surgery in stage IIIa and even stage IIIb disease. Randomized studies of postoperative chemotherapy demonstrated a 5% improvement in 5-year survival over adjuvant-free treatment. Postoperative chemoradiation showed no advantage over postoperative radiotherapy. Several trials that are ongoing or whose accrual was recently completed should further define the role of perioperative chemotherapy in resectable NSCLC and of trimodality treatments in advanced disease. Targeted agents are being developed in the postoperative setting. New schedules of chemoradiation with higher therapeutic indexes are also being investigated in nonresectable stage III NSCLC.     

Lung cancer in women: clinical features and factors related to survival

Lung cancer in women is increasing in worldwide. This process beginning with the difference on the susceptibility of lung cancer in women smokers may be different from men in the prognosis. In this study, it was aimed to evaluate the clinical features, and prognostic factors of female patients with lung cancer diagnosed between January 2000-December 2005. The data of 109 patients data was evaluated. The mean age was 59.40 +/- 11.56 and 17 (15.6%) patients were smokers. In 20 patients (18.3%) having a family history of cancer, 55% of them had a relative with lung cancer. In admission, cough (81.7%), dyspnea (78.9%), chest pain (40.3%) were the most frequent presenting symptoms. The most common site of tumoral lesion in bronchoscopy were right upper lobe (16.5%). In the study group histopathological diagnosis were as follows; adenocarcinoma (44.9%), small cell lung cancer (SCLC) (19.3%), squamous cell (10.1%), non-small cell lung cancer (NSCLC) --undefined (22.0%), carsinoid tumors (2.8%), in non-smokers adenocarcinoma was significantly higher than smokers (44.9%/17.7%) (p< 0.001). 61.9% of NSCLC patients and 57.1% of SCLC patients had a stage IV disease at the initial evaluation. The most common sites of metastasis were bone (28.4%), liver (22.9%), and brain (11.9%), there were multiple metastasis in 10 patients. Median survival time was found as 288 days. In univariate analysis, comorbidity, primary tumor stage, bone metastasis, advanced disease stage, ECOG performance score >or= 2 and supportive care alone were poor prognostic factors. In multivariate analysis, poor performance status (p= 0.003), advanced disease stage (p= 0.002) and bone metastasis (p= 0.04) were negatively related to survival. In women, the definition of the clinical features, disease course and survival related factors may contribute to our future treatment approaches based on our national data.     

Outcome of patients with cancer of the esophagogastric junction in relation to histology and surgical strategy

BACKGROUND/AIMS: The impact of histologic type and surgical strategy on survival of patients with cancer of the esophagogastric junction is debated. Thus, we evaluated the relationship between cancer histologic type (adenocarcinoma vs. squamous cell carcinoma) on long-term survival and the results of two different surgical techniques on outcome. METHODOLOGY: Two hundred and one patients with neoplasm of the esophagogastric junction were prospectively observed, and 133 patients (66%) underwent operation with curative intent. The results of two resective techniques, total gastrectomy with a thoraco-abdominal approach and total gastrectomy with a trans-hiatal approach were also compared in a subgroup with Siewert's type II and III cancer. RESULTS: Seventy-seven patients had an adenocarcinoma and 56 a squamous cell carcinoma. The 5-year proportion of survival was 35% in the adenocarcinoma group versus 40% in the squamous group (log-rank = 0.92), and the mean length of survival was 35 +/- 3 months and 34 +/- 5 months, respectively. The overall incidence of postoperative morbidity and the length of hospital stay were both significantly lower in the trans-hiatal group than in the thoraco-abdominal group (31% vs. 51%; p = 0.04; and 15.6 days vs. 23.2 days; p = 0.02 respectively), while the 5-year patient survival was 37% thoraco-abdominal approach and 42% in the trans-hiatal approach (log-rank = 0.62). CONCLUSIONS: In the present population, histologic type of the esophagogastric cancer was not a determinant factor for long-term survival. The transhiatal approach resulted in a better postoperative outcome without compromising surgical radicality and patient survival.     

Changes in colorectal cancer over a 15-year period in a single United States city

OBJECTIVE: The aim of this study was to identify colorectal cancer trends in different patient groups in one region. METHODS: We reviewed the records of all patients with colorectal cancer who were seen at two hospitals in Columbia, SC, between 1981 and 1995. Patients were divided into three 5-yr cohorts (cohort 1, 1981-1985; cohort 2, 1986-1990; and cohort 3, 1991-1995). We recorded demographic data, histological type, tumor stage, grade, and survival. RESULTS: A total of 1395 patients were diagnosed, of whom 1252 had adenocarcinoma. Mean age of diagnosis was 64.5 yr in black and 66 in white patients (p = 0.036). Adenocarcinoma proximal to the splenic flexure was found in 62% of women and 49% of men (p < 0.001), and in 51% of black and 44% of white patients (p = 0.08). Proximal cancers accounted for 61%, 48%, and 32% of cohorts 1, 2, and 3, respectively. The proportions of patients with advanced stage (III and IV) adenocarcinoma in the three cohorts were 54%, 47%, and 40%, respectively (p = 0.001). Median survival for adenocarcinoma was 23.7, 23.5, and 23.1 months in cohorts 1, 2, and 3 (p = 0.9). CONCLUSIONS: The prevalence and demographics of colorectal cancer have been fairly stable at this center. There has been a significant decrease in proximal cancers. Although adenocarcinoma is being diagnosed at an earlier stage, this has not affected survival. Colonoscopy may be the most appropriate screening method in women and in black patients, in whom proximal cancers are more often found.     

老年与青年晚期非小细胞肺癌患者的临床特点及预后分析

目的 回顾性分析老年及青年晚期非小细胞肺癌(NSCLC)患者的临床特点、治疗及预后因素的异同.方法 收集北京大学临床肿瘤学院胸部肿瘤内科1995年3月至2007年5月住院的晚期NSCLC 399例,其中老年(≥70岁)256例,男199例,女57例;青年(≤45岁)143例,男77例,女66例,均接受一线化疗.采用Kaplan-Meier及Cox回归法分析生存期及其影响因素,疗效相关性分析采用χ~2检验.结果 (1)青年组及老年组均以男性、腺癌、Ⅳ期患者居多,但青年组与老年组相比,女性[46.2%(66/143),22.3%(57/256)]、腺癌[71.3%(102/143),54.7%(105/256)]、Ⅳ期患者[72.7%(104/143),61.7%(158/256)]所占比例高;青年女性吸烟率高达95.5%(63/66);(2)一线治疗的疾病控制率与年龄无关;含铂联合化疗有利于疾病的控制,符合世界卫生组织毒性分级标准3-4度血液学毒性的病例数两组无差异;(3)老年组中位无进展生存期(PFS)为149 d(95%CI为119.5～178.5 d),青年组中位PFS为126 d(95%CI为84.0～168.0 d),两组比较差异无统计学意义;(4)老年组中位生存期为398 d(95%CI为330.3～465.7 d),青年组中位生存期为424 d(95%CI为359.7～488.3 d);(5)东方肿瘤合作组评分为0～1、一线治疗达到疾病控制、以三代新药或靶向治疗为二线治疗者等因素是有利于生存的独立预后因素.结论 青年组中,女性、腺癌、Ⅳ期患者所占比例较老年组高;青年女性NSCLC发生率的增加可能与吸烟有一定关系;年龄与一线治疗的疾病控制率、PFS及总生存期均无相关性.     

Adjuvant Chemotherapy for Early-Stage Non-small Cell Lung Cancer

Lung cancer is the leading cause of cancer-related mortality in the developed world. Non-small cell lung cancer (NSCLC) represents 85% of cases of lung cancer, and patients have a poor 5-year survival rate. Approximately one third of NSCLC patients present with early-stage disease that is amenable to potentially curative resection and multimodality therapy. Several randomized trials now have confirmed the survival benefit with adjuvant platinum-based chemotherapy, as seen in the 1995 meta-analysis from the NSCLC Collaborative Group. The International Adjuvant Lung Cancer Collaborative Group Trial demonstrated a 4.5% improvement in survival for patients with stage I to III NSCLC. Studies from Japan have reported an improvement of 15.4% in the 5-year survival rate among patients with T1N0 disease after they had received adjuvant therapy with a combination of platinum and uracil-tegafur, and an improvement in the 5-year survival of 11% rate favoring chemotherapy with uracil-tegafur in a subgroup analysis of patients with T2N0 disease. Two recently published meta-analyses have estimated a relative risk reduction in mortality of 11 to 13% at 5 years. Significant improvement in the long-term survival rate has been demonstrated for patients with stage IB and II disease by the Cancer and Leukemia Group B 9633 trial (4-year survival rate, 12%) and the The National Cancer Institute of Canada Clinical Trials Group BR.10 trial (5-year survival rate, 15%; risk reduction for recurrence, 40%). Thus, there is compelling evidence to now recommend adjuvant platinum-based combination chemotherapy for patients after resection of early-stage NSCLC.     

Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer

BACKGROUND: Positron emission tomography (PET) scanning is used increasingly to detect and stage lung cancer, but the test performance characteristics and relationship of PET to patient outcomes remain undefined. OBJECTIVE: To determine the test performance characteristics and relationship of PET scanning stage to patient outcomes relative to the 1997 International System for the Staging of Lung Cancer. DESIGN: Survival analysis using pathologic staging as the criterion standard for comparison of survival as predicted by staging by PET and CT. SETTING: University-based hospital. PATIENTS: All consecutive patients undergoing PET scanning for the evaluation of possible non-small cell lung cancer (NSCLC) during a 5-year period. Main outcome measures: Long-term survival of patients with NSCLC after staging by PET. RESULTS: One hundred fifty-two thoracic PET scans were obtained for the staging of possible NSCLC during a 5-year period. One hundred twenty-three patients (81%) demonstrated increased (18)F-fluorodeoxyglucose uptake. The overall sensitivity and specificity of PET for detecting malignancy were 95% and 67%, respectively, compared with 100% and 27% for chest CT. PET and CT had similar accuracy for staging the overall extent of disease (91% and 89%, respectively). PET stage correlated highly with survival using either nodal location or overall stage (p = 0.003, p = 0.002), as did pathologic staging (p = 0.0001, p = 0.0001). CT scan results did not accurately predict survival (p = 0.608, p = 0.338). CONCLUSION: PET scanning is a highly sensitive technologic advance in detecting and staging of thoracic malignancy and may more accurately predict the likelihood of long-term survival in patients with NSCLC than chest CT does.     

Survival of patients with advanced non-small-cell lung cancer at Ubon Ratchathani Cancer Center, Thailand

This survival analysis was conducted at Ubon Ratchathani Cancer Center to determine the prognostic factors for survival of patients with stage IIIA, stage IIIB, and stage IV non-small-cell lung cancer (NSCLC) patients treated at the center between 1997-2001. The study sample included 210 patients with non-small-cell lung cancer. Diagnosis and staging were defined employing the TNM system. The majority of lung cancer patients were smokers (66.7%), lived in Ubon Ratchathani Province (40.0%), male (77.6%), and agriculturalists (74.8%). Seventy-seven percent of patients died within five years, 19.5% were lost to follow-up and 2.9% were still alive in 2003. The estimated median survival time was 6.3 months (95% CI 5.4-7.3); the median survival times for stages IIIA, IIIB, and IV were 16.3, 7.0, and 4.5 months, respectively. The overall 1-, 2- and 3-year survival rates of NSCLC were 28.9, 7.9, and 3.3, respectively. The differences in survival of patients in the various stages of the disease were statistically significant (p < 0.0001), adjusted for age and sex. Treatment with combination methods and at an early stage in the disease were associated with significant prolongation of survival. For stage IIIA, the estimated median survival times by treatment with chemotherapy was 7.0 months, radiotherapy was 16.0 months, surgery and others 16.3 months, and chemotherapy plus radiotherapy was 19.5 months. However, only chemotherapy versus surgery and others was significantly different (p = 0.0307). The median survival times for stage IIIB patients treated with chemotherapy, radiotherapy, surgery and others, chemotherapy and radiotherapy, and supportive treatment were 7.0, 7.0, 9.0, 14.7, and 3.0 months, respectively. The differences between surgery and others versus supportive treatment, chemotherapy and radiotherapy versus supportive treatment were significantly different (p = 0.0392, p = 0.0433, respectively). For stage IV, the median survival times for patients treated with chemotherapy, radiotherapy, chemotherapy and radiotherapy, and supportive treatment were 5.0, 4.3, 6.5, and 1.0 months, respectively. The differences between chemotherapy, radiotherapy, chemotherapy and radiotherapy versus supportive treatment, all were significantly different (p = 0.0020, p < 0.0001, p < 0.0001, respectively). The 2-year survival rates for stages IIIA, IIIB, and IV were 16.0, 4.1, and 2.2%, respectively. The results of the study show that stage IIIA has the longest survival time. They also show that appropriate treatment is a significant factor in improving the survival of lung cancer patients.     

Causes of death after surgery for colon cancer-impact of other diseases,urgent admittance,and gender

Abstract

Objective. In patients with colon cancer, high age and comorbidity is common. In this population-based retrospective study we have investigated causes of death and the influence of urgent operation, and gender on survival. Material and methods. Medical records of 413 patients with verified colon cancer were reviewed. The diagnosis was made during 2000–2006 and operation was performed in 385 patients (93%). Results. The overall 5-year survival after surgery was 48.3%. At the end of the follow-up, 128 patients (54.9%) had verified colon cancer when they died but 105 patients (45.1%) had no signs of colon cancer. Their 5-year survival was 5.5% and 41.9%, respectively (p < 0.0001). Median survival time was significantly shorter after urgent compared with elective admittance, 20.7 months versus 77.9 months, and the 5-year survival 32.4% versus 57.9% (p = 0.0001). The tumor stage at operation was more favorable in patients dying with no signs of colon cancer than in those dying with cancer regarding stage I–II (66.7% versus 16.4%), and stage IV (1.0% versus 53.1%), but not regarding stage III (30.5% versus 29.7%). The overall survival in women who were operated was longer than in men (p = 0.045) as well as survival after elective admittance (p = 0.013). Conclusion. After a median follow-up of 56.1 months almost half of the patients who were dead had died from other causes than colon cancer. Ten percent of those patients had an incorrectly reported diagnosis of colon cancer as cause of death. Urgent admittance was associated with reduced survival time. The median survival time was longer in women than in men.     

Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer

PURPOSES: The standard treatment of stage I non-small cell lung cancer (NSCLC) is surgical resection. Some patients are poor surgical candidates due to severe comorbid medical conditions. Radiotherapy alone has historically been used in this patient population with limited success. Radiofrequency ablation (RFA) is an image-guided, thermally mediated ablative technique recently applied to lung tumors. Combination therapy with both these treatments has not been previously performed. We report our experience with combined CT-guided RFA and conventional radiotherapy in 24 medically inoperable patients with a minimum of 2-year study follow-up in surviving patients. PATIENTS AND METHODS: Twenty-four consecutive, medically inoperable patients with biopsy-proven, stage I NSCLC were treated with CT-guided RFA followed by radiotherapy to a dose of 66 Gy. RFA was performed with a single or cluster cool-tip F electrode; 21 patients were staged before therapy using fluorodeoxyglucose-positron emission tomography. RESULTS: There were 14 women and 10 men (median age, 76 years; range, 58 to 85 years). The histologic subtypes were squamous cell (n = 13), adenocarcinoma (n = 5), and undifferentiated (n = 6). All patients received RFA followed by three-dimensional conformal radiotherapy. There were no treatment-related deaths or grade 3/4 toxicities. Pneumothorax requiring chest tubes developed in three patients (12.5%). At a mean follow-up period of 26.7 months (range, 6 to 65 months), 14 patients (58.3%) died, with cumulative survival rates of 50% and 39% at the end of 2 years and 5 years, respectively. Ten of the deaths were cancer related. Two patients had local recurrence (8.3%), while nine patients had systemic metastatic disease. Three patients died of respiratory failure with no evidence of active disease, and one patient died of a cerebrovascular accident at 18-month follow-up. Pleural effusions developed after treatment in six patients (25%), which proved to be malignant in one patient. CONCLUSION: RFA followed by conventional radiotherapy is feasible in this population of medically inoperable stage I NSCLC patients. Procedural complication rates are low, and no additional major toxicities were seen despite the addition of RFA. Local control and survival rates appear to be better than with radiotherapy alone.     

Prognostic significance of p53 status in non-small cell lung cancer in correlation with postoperative adjuvant therapy

BACKGROUND AND OBJECTIVE: Significant factors in the prognosis of p53 status in non-small cell lung cancer (NSCLC) remain controversial; some clinical studies have documented that p53 abnormality is a significant factor in predicting poor prognosis, and others failed. In the present study, we examined whether or not adjuvant therapy may influence the prognostic significance. METHODS: 217 patients with pathologic stage I disease were reviewed. As postoperative adjuvant therapy, UFT, an oral 5-fluorouracil derivative, was administered to 73 patients; p53 status was determined immunohistochemically. RESULTS: The 5-year survival rate for tumor with aberrant p53 expression was 66.4 %--significantly lower than that for tumor without aberrant p53 expression (79.7%, p = 0.023). The prognostic significance of p53 status was enhanced in patients who received UFT; 5-year survival rates for tumor with and without aberrant p53 expression were 68.8 and 94.7%, respectively (p = 0.002). In patients who did not receive UFT, the difference did not reach statistical significance (5-year survival rates: 65.5 and 71.5%, respectively; p = 0.267). CONCLUSIONS: This study demonstrates that postoperative survival is improved by UFT administration in patients with normal p53 function, but not in those without normal p53 function.     

Histomorphological tumor regression grading of esophageal carcinoma after neoadjuvant radiochemotherapy: which score to use?

Histopathological tumor regression grade (TRG) has been shown to be a prognostic factor in patients with esophageal cancer after neoadjuvant radiochemotherapy (RCT). The system introduced by Mandard to group TRG (Cancer 1994;73:2680-2686) has been used to analyse and discuss its prognostic significance on survival in a single institution retrospective analysis: TRG 1 (complete regression) - TRG 5 (absence of regressive changes). Sixty patients with locally advanced (T3/4 or N1) adenocarcinoma or squamous cell carcinoma received cisplatin-based RCT. Three to four weeks later operation for curative intent was performed. Median follow-up was 17.7 months. Histopathological tumor stages were stage 0 in 17%, stage I in 10%, stage II in 60%, stage III in 12% and stage IVA in 1%. The 5-year overall survival (OS) rate was 35%. In univariate analysis, ypN-status and TRG correlated significantly with OS (P = 0.004, P = 0.0008, respectively). While OS of TRG 1 differed significantly from all other groups, no differences in OS between the other TRG groups were seen. Patients with complete tumor regression after neoadjuvant RCT showed a much better survival than patients with tumors that responded less to induction therapy. Further qualitative subdivision of tumor regression could not identify patient groups with significant differences in prognosis. After comparing our data with the literature, it is reasonable to consider classifying all patients into 'Complete tumor regression' and 'Incomplete tumor regression'.