Prognostic value of the neutrophil to lymphocyte ratio in lung cancer: A meta-analysis

Recently, a series of studies explored the correlation between the neutrophil to lymphocyte ratio and the prognosis of lung cancer. However, the current opinion regarding the prognostic role of the neutrophil to lymphocyte ratio in lung cancer is inconsistent. We performed a meta-analysis of published articles to investigate the prognostic value of the neutrophil to lymphocyte ratio in lung cancer. The hazard ratio (HR) and its 95% confidence interval (CI) were calculated. An elevated neutrophil to lymphocyte ratio predicted worse overall survival, with a pooled HR of 1.243 (95%CI: 1.106-1.397; Pheterogeneity=0.001) from multivariate studies and 1.867 (95%CI: 1.487-2.344; Pheterogeneity=0.047) from univariate studies. Subgroup analysis showed that a high neutrophil to lymphocyte ratio yielded worse overall survival in non-small cell lung cancer (NSCLC) (HR=1.192, 95%CI: 1.061-1.399; Pheterogeneity=0.003) as well as small cell lung cancer (SCLC) (HR=1.550, 95% CI: 1.156-2.077; Pheterogeneity=0.625) in multivariate studies. The synthesized evidence from this meta-analysis of published articles demonstrated that an elevated neutrophil to lymphocyte ratio was a predictor of poor overall survival in patients with lung cancer. .

The effect of small-molecular-weight heparin added to chemotherapy on survival in small-cell lung cancer - A retrospective analysis.

Aims and Background: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor and associated with alterations in the coagulation system. Addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) had resulted in increase in survival. The present retrospective trial was designed to determine whether the duration of dalteparin usage has an effect on progression and survival. Materials and Methods: The medical records of 67 patients with SCLC who were given cisplatin-etoposide and concomitant LMWH (dalteparin) was evaluated retrospectively. Results: Median follow-up of patients was 11.3 months. Outcome: 10.6% complete response, 3.0% good partial response, 36.4% partial response, 10.6% stable disease, and 39.4% progressive disease. Side-effects were seen in 40.3% of the patients. Median dalteparin duration was 6,1 months. According the duration of dalteparin patients were grouped in three: who took dalteparin less than 4 months (Group A), 4-6 months (Group B) and more than 6 months (Group C). Mean overall survival (OS) in Group A was 6.5 months, in Group B 11.8 months, and Group C 14.6 months. Mean OS in Group B and C were statistically significantly (P < 0.001) longer than Group A, between Group B and C there was not any significant difference (P = 0.037). Mean progression free survival (PFS) was 9 months. Conclusions: The CT plus LMWH minimum 4 months long is well-tolerable, and may improve PFS and OS in patients with SCLC. For treatment of patients with SCLC CT plus LMWH may be considered as effective future-therapy, and further multi-centre randomised prospective clinical trials must be done to determine the new standard treatment approach for SCLC.

The start of chemotherapy until the end of radiotherapy in patients with limited-stage small cell lung cancer

BACKGROUND/AIMS: Chemotherapy combined with radiation therapy is the standard treatment for limited stage small cell lung cancer (LS-SCLC). Although numerous studies indicate that the overall duration of chemoradiotherapy is the most relevant predictor of outcome, the optimal chemotherapy and radiation schedule for LS-SCLC remains controversial. Therefore we analyzed the time from the start of any treatment until the end of radiotherapy (SER) in patients with LS-SCLC. METHODS: We retrospectively analyzed 29 patients diagnosed histologically with LS-SCLC and divided them into two groups: a short SER group ( 60 days) group. Patients were treated with irinotecan-based chemotherapy and thoracic radiotherapy. RESULTS: Sixteen patients were in the short SER group and 13 patients were in the long SER group. Short SER significantly prolonged survival rate (p = 0.03) compared with that of long SER. However, no significant differences in side effects were observed. CONCLUSIONS: Short SER should be considered to improve the outcome of concurrent chemoradiotherapy for LS-SCLC.

Factors affecting 30-month survival in lung cancer patients.

Background & objectives: Age adjusted incidence rate of lung cancer in India ranges from 7.4 to 13.1 per 100,000 among males and 3.9 to 5.8 per 100,000 among females. The factors affecting survival in lung cancer patients in India are not fully understood. The current study was undertaken to evaluate the factors affecting survival in patients diagnosed with lung cancer attending a tertiary care cancer institute in Bangalore, Karnataka, India. Methods: Consecutive patients with primary lung cancer attending Bangalore Institute of Oncology, a tertiary care centre at Bangalore, between 2006 and 2009 were included. Demographic, clinical, radiological data were collected retrospectively from the medical records. Results: A total of 170 consecutive subjects (128 males, 42 females) diagnosed to have lung cancer; 151 non-small cell lung cancer (NSCLC) and 19 small cell lung cancer (SCLC) were included. A higher proportion of never-smokers (54.1%) were observed, mostly presenting below the age of 60 yr. Most subjects were in stage IV and III at the time of diagnosis. More than 50 per cent of patients presented with late stage lung cancer even though the duration of symptoms is less than 2 months. The 30-month overall survival rates for smokers and never-smokers were 32 and 49 per cent, respectively. No significant differences were observed in 30 month survival based on age at presentation, gender and type of lung cancer. Cox proportional hazards model identified never-smokers and duration of symptoms less than 1 month as factors adversely affecting survival. Interpretation & conclusions: Our results showed that lung cancer in Indians involved younger subjects and associated with poorer survival as compared to other ethnic population. Studies on large sample need to be done to evaluate risk factors in lung cancer patients.

Trinta anos de irradiação craniana profilática em pacientes com câncer de pulmão de pequenas células: uma meta-análise de ensaios clínicos randomizados / Thirty years of prophylactic cranial irradiation in patients with small cell lung cancer: a meta-analysis of randomized clinical trials

OBJETIVO: Determinar o papel da irradiação craniana profilática (ICP) em pacientes com câncer de pulmão de pequenas células (CPPC). MÉTODOS: Foi realizada uma pesquisa para selecionar estudos em várias bases de dados, com os seguintes critérios de inclusão: ensaios clínicos randomizados, publicados em periódicos ou em anais de congressos nos últimos 30 anos, avaliando o papel da ICP sobre a mortalidade em pacientes com CPPC que receberam ICP ou não. RESULTADOS: Foram considerados elegíveis 16 estudos clínicos randomizados, os quais envolveram 1.983 pacientes. Entre esses, 1.021 foram submetidos a ICP e 962 não foram submetidos a ICP. Houve uma redução absoluta na mortalidade de 4,4% nos pacientes submetidos a ICP quando comparados com o grupo controle (OR = 0,73; IC95%: 0,57-0,97; p = 0,01), principalmente naqueles com resposta completa à quimioterapia de indução (OR = 0,68; IC95%: 0,50-0,93; p = 0.02) e que foram submetidos a ICP ao término desse tratamento (OR = 0,68; IC95%: 0,49-0,94; p = 0.03). A diminuição da mortalidade não se correlacionou com o estádio da doença: doença limitada (OR = 0,73; IC95%: 0,55-0,97; p = 0,03) e doença extensa (OR = 0,48; IC95%: 0,26-0,87; p = 0,02). CONCLUSÕES: Nossos achados sugerem que a ICP reduz a mortalidade em pacientes com CPPC, principalmente naqueles com resposta a quimioterapia de indução e que sejam submetidos a ICP ao término desse tratamento, independentemente do estadiamento da doença.

OBJECTIVE: To determine the role of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC). METHODS: We searched various databases, selecting randomized clinical trials published in journals or conference proceedings within the last 30 years and investigating the role of PCI in the mortality of patients with SCLC, submitted to PCI or not. RESULTS: Sixteen randomized clinical trials, collectively involving 1,983 patients, were considered eligible for inclusion. Of those 1,983 patients, 1,021 were submitted to PCI and 962 were not. Overall mortality was 4.4% lower in the patients submitted to PCI than in those who were not (OR = 0.73; 95% CI: 0.57-0.97; p = 0.01), especially among the patients showing a complete response after induction chemotherapy (OR = 0.68; 95% CI: 0.50-0.93; p = 0.02) and in those submitted to PCI after that treatment (OR = 0.68; 95% CI: 0.49-0.94; p = 0.03). That decrease did not correlate with the stage of the disease: limited disease (OR = 0.73; 95% CI: 0.55-0.97; p = 0.03); and extensive disease (OR = 0.48; 95% CI: 0.26-0.87; p = 0.02). CONCLUSIONS: Our findings suggest that PCI decreases mortality in patients with SCLC, especially in those showing a complete response after induction chemotherapy and in those submitted to PCI after that treatment, regardless of the stage of the disease.

Características de pacientes com câncer de pulmão na cidade de Manaus / Characteristics of patients with lung cancer in the city of Manaus, Brazil

OBJETIVO: Analisar as características de pacientes com câncer de pulmão. MÉTODOS: Estudo retrospectivo e descritivo dos pacientes com diagnóstico histopatológico de câncer de pulmão entre 1995 e 2002 em Manaus (AM). Os dados dos pacientes foram coletados nos arquivos médicos de três hospitais. As análises estatísticas foram realizadas, e as curvas de sobrevida geradas a partir do estimador atuarial. RESULTADOS: Dos 352 pacientes selecionados, 262 (74,4 por cento) eram do sexo masculino e 90 (25,6 por cento) do feminino. A média de idade foi de 62 anos. Os seguintes tipos histológicos foram encontrados: carcinoma de células escamosas, 62,8 por cento; adenocarcinoma, 24,7 por cento; carcinoma de pequenas células, 9,1 por cento; e carcinoma de grandes células, 3,4 por cento. Os estádios IIIB e IV foram os mais comuns, com uma frequência de 45 por cento e 21,5 por cento, respectivamente. Da amostra total, 73,4 por cento foram submetidos a tratamento. Desses, 51,4 por cento foram submetidos à radioterapia; 16,6 por cento, à cirurgia; 15,8 por cento, à quimioterapia; e 16,2 por cento, à radioterapia associada à quimioterapia. Os níveis de sobrevida acumulada foram baixos: a sobrevida em três anos foi de 6,5 por cento e a sobrevida em cinco anos foi de 3,5 por cento. CONCLUSÕES: Este grupo de pacientes com câncer de pulmão apresentou uma sobrevida muito pequena, divergindo dos resultados encontrados na literatura. Isto é provavelmente decorrente da dificuldade de acesso ao sistema de saúde especializado e do estágio avançado do diagnóstico.

OBJECTIVE: To analyze the characteristics of patients with lung cancer. METHODS: A retrospective descriptive study of patients receiving a histopathological diagnosis of lung cancer between 1995 and 2002 in the city of Manaus, Brazil. Data were collected from the medical archives of three hospitals. Statistical analyses were carried out, and survival curves were generated by means of an actuarial estimator. RESULTS: Of the 352 patients selected, 262 (74.4 percent) were male and 90 (25.6 percent) were female. The mean age was 62 years. The following histological types were identified: squamous cell carcinoma, 62.8 percent; adenocarcinoma, 24.7 percent; small cell carcinoma, 9.1 percent; and large cell carcinoma, 3.4 percent. The most common stages were stages IIIB and IV, in 45 percent and 21.5 percent, respectively. Of the total sample, 73.4 percent were submitted to treatment. Of these, 51.4 percent underwent radiotherapy; 16.6 percent, surgery; 15.8 percent, chemotherapy; and 16.2 percent, radiotherapy in association with chemotherapy. Cumulative survival rates were low: three-year survival was 6.5 percent, and five-year survival was 3.5 percent. CONCLUSIONS: In this group of patients with lung cancer, survival rates were considerably lower than those reported in the literature. This might be attributable to the limited access to the specialized health care system and the advanced stage of the disease at diagnosis.

Diagnóstico e prognóstico dos tumores pulmonares neuroendócrinos mediante microscopia eletrônica e análise multivariavel de agrupamento / Using electron microscopy and multivariate cluster analysis to determine diagnosis and prognosis in cases of neuroendocrine lung carcinoma

OBJECTIVE: To establish reproducible electron microscopic criteria for identifying the four major types of neuroendocrine tumors of the lung: carcinoid; atypical carcinoid; large cell neuroendocrine carcinoma; and small cell carcinoma. METHODS: Measurements were made on electron micrographs using a digital image analyzer. Sixteen morphometric variables related to tumor cell differentiation were assessed in 27 tumors. The examination under electron microscopy revealed that all of the tumors could be classified as belonging to one of the four categories listed above. Cluster analysis of the morphometry variables was used to group the tumors into three clusters, and Kaplan-Meier survival function curves were employed in order to draw correlations between each cluster and survival. RESULTS: All three clusters of neuroendocrine carcinomas were found to be associated with survival curves, demonstrating the prognostic significance of electron microscopic features. The tumors fell into three well-defined clusters, which represent the spectrum of neuroendocrine differentiation: typical carcinoid (cluster 1); atypical carcinoid and large cell neuroendocrine carcinoma (cluster 2); and small cell carcinoma (cluster 3). Cluster 2 represents an intermediate step in neuroendocrine carcinogenesis, between typical carcinoid tumors and small cell carcinomas. CONCLUSIONS: Our findings confirm that electron microscopy is useful in making the diagnosis and prognosis in cases of lung tumor.

OBJETIVO: Estabelecer, com ajuda do microscópio eletrônico, critérios que possibilitem uma diferenciação mais exata entre os quatro tipos maiores de tumores neuroendócrinos pulmonares: tumor carcinóide típico e atípico, carcinoma de grandes células neuroendócrino e carcinoma de pequenas células. MÉTODOS: Todos os tumores foram avaliados morfometricamente e 16 variáveis foram relacionadas com diferenciação das células tumorais; estas variáveis foram analisadas sob microscopia eletrônica com ajuda de um analisador de imagem digital em 27 tumores. A avaliação através da microscopia eletrônica revelou que todos os tumors investigados podiam ser classificados a um dos quarto tipos listados acima. A análise das variáveis morfométricas foi usada para agrupar os tumores em três grandes grupos, os quais foram relacionados à sobrevivência pelas curvas de Kaplan Meier. RESULTADOS: Os três grupos de carcinoma neuroendócrino associaram-se às curvas da sobrevivência, as quais mostraram características ultrastruturais na microscopia eletrônica de significância prognóstica distinta. Os tumores foram contidos em três grupos bem definidos, que representam o espectro da diferenciação neuroendócrina: tumor carcinóide (grupo 1); tumor carcinóide atípico e carcinoma de grandes células neuroendócrino (grupo 2); e carcinoma de pequenas células (grupo 3). O grupo 2 representa um espectro intermediário na carcinogênese neuroendócrina, entre o carcinóide típico e o carcinoma de pequenas células. CONCLUSÕES: Nossos achados confirmam que a microscopia eletrônica é uma ferramenta útil no diagnóstico e prognóstico dos casos de tumores pulmonares.