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.

Factors associated with the development of tuberculosis in BCG immunized children.

In this hospital-based case-control study, children attending Siriraj Hospital and Queen Sirikit National Institute of Child Health from 1 December 2002 to 30 June 2003 were studied to define factors associated with TB in BCG immunized children (n = 260). Subjects of the same age and sex were divided into case and control groups by tuberculosis status. Caregivers were interviewed with a structured questionnaire. Data were analyzed by univariate analysis and multivariate analysis for biological factors (birth weight, health status, nutritional status), socioeconomic factors (parental education, education of caregiver, parental occupation, household incomes, and stability of household incomes), and environmental factors (history of contact with a tuberculosis patient, housing ventilation, child's bedroom ventilation, biomass smoke, passive smoking, crowded family and crowded in child's bedroom). Our findings show that children who had contact with TB patients had a very high risk of tuberculosis, even though they were vaccinated at birth. The risks vary according to the closeness level: very close (OR 85.67, 95%CI = 11.33-647.79), close (OR 31.11, 95%CI = 3.93-246.22) and not close (OR 32.70, 95%CI = 4.18-255.94). In order to identify the effect of others variables, the data was reanalyzed only in the group with no history of TB patient contacts (n = 192). Living in a crowded family, which was reflected by an average of 5 or more persons per room, also increased the risk (OR 11.18, 95%CI = 2.35-53.20). The other factor that increased the risk for tuberculosis was passive smoking. Children who were exposed to passive smoking had a 9.31 times increased risk of getting tuberculosis (95%CI = 3.14-27.58). These findings suggest that the public health department must develop a TB surveillance system in high TB prevalence areas, and in high density communities, and encourage smokers in every family to avoid smoking near children. Latent tuberculosis treatment recommendations for TB control cluster, as set by the Bureau of AIDS/TB and STIs, must be implemented in all health centers and an effective TB control program must be reinforced.

Cigarette smoking and its relation to pulmonary tuberculosis in adults.

The purpose of this hospital-based case-control study is to determine the effect of passive and active smoking on pulmonary TB in adults. The study subjects were 100 new pulmonary TB cases diagnosed at TB Division, and age-sex matched 100 non-TB cases from patients admitted to Taksin Hospital and healthy subjects who came for annual physical check-up at either the outpatient clinic of the TB division or Taksin Hospital, during May 2001 to October 2001. All subjects had blood tests and only persons who were HIV-negative, DM-negative and free of other lung diseases were included. Data were collected by direct interview using questionnaires. Multivariate analysis of cigarette smoking related to pulmonary TB in adults was performed. The factors related to pulmonary TB in adults were current active smoking regardless of passive smoking exposure. There was a significant association between early age at initiation of smoking and TB. Active (current + ex-active) smokers who started smoking at age 15-20 years had a higher risk of pulmonary TB compared to others (OR = 3.18, 95% CI = 1.15-8.77); as well as the long duration of smoking: persons who had smoked >10 years had a higher risk of pulmonary TB (OR = 2.96, 95% CI = 1.06-8.22). There was a relationship between pulmonary TB and the amount of smoking exposure. Those who smoked >10 cigarettes/day (OR = 3.98, 95% CI = 1.26-12.60) or >3 days/week (OR = 2.68, 95% CI = 1.01-7.09) had higher risk of pulmonary TB compared to non-smokers. Passive smokers who were exposed to tobacco smoke >3 times/week outside the home had a higher risk of pulmonary TB than those with exposure < or =3 times/week (OR = 3.13, 95% CI = 1.07-9.17). It was also found that the effects of passive smoking in the office and/or neighborhood were strong. Persons with such exposures had a higher risk of pulmonary TB than no exposure or exposure < or =3 times/week from either or both places (OR = 4.62, 95% CI = 1.68-14.98). Therefore, an effective anti-smoking campaign is expected to have a positive repercussion on TB incidence. Smoking cessation must be considered and promoted by all levels of health care providers.