ABSTRACT
BACKGROUND: Central nervous system is a common site of metastasis in NSCLC and confers worse prognosis and quality of life. The aim of this prospective study was to evaluate the prognostic significance of clinical-pathological factors (CPF), serum CEA levels, and EGFR and HER2 tissue-expression in brain metastasis (BM) and overall survival (OS) in patients with advanced NSCLC. METHODS: In a prospective manner, we studied 293 patients with NSCLC in IIIB-IV clinical stage. They received standard chemotherapy. CEA was measured prior to treatment; EGFR and HER2 were evaluated by immunohistochemistry. BM development was confirmed by MRI in symptomatic patients. RESULTS: BM developed in 27, and 32% of patients at 1 and 2 years of diagnosis with adenocarcinoma (RR 5.2; 95% CI, 1.002-29; p = 0.05) and CEA > or = 40 ng/mL (RR 11.4; 95% CI, 1.7-74; p < 0.01) as independent associated factors. EGFR and HER2 were not statistically significant. Masculine gender (RR 1.4; 95% CI, 1.002-1.9; p = 0.048), poor performance status (RR 1.8; 95% CI, 1.5-2.3; p = 0.002), advanced clinical stage (RR 1.44; 95% CI, 1.02-2; p = 0.04), CEA > or = 40 ng/mL (RR 1.5; 95% CI, 1.09-2.2; p = 0.014) and EGFR expression (RR 1.6; 95% CI, 1.4-1.9; p = 0.012) were independent associated factors to worse OS. CONCLUSION: High CEA serum level is a risk factor for BM development and is associated with poor prognosis in patients with advanced NSCLC. Surface expression of CEA in tumor cells could be the physiopathological mechanism for invasion to CNS.
Subject(s)
Brain Neoplasms/secondary , Carcinoembryonic Antigen/blood , Carcinoma, Non-Small-Cell Lung/pathology , Lung Neoplasms/pathology , Brain Neoplasms/blood , Carcinoma, Non-Small-Cell Lung/blood , Carcinoma, Non-Small-Cell Lung/drug therapy , ErbB Receptors/analysis , Female , Follow-Up Studies , Humans , Immunoassay/methods , Immunohistochemistry , Luminescent Measurements/methods , Lung/metabolism , Lung/pathology , Lung Neoplasms/blood , Lung Neoplasms/drug therapy , Male , Middle Aged , Multivariate Analysis , Neoplasm Staging , Prognosis , Prospective Studies , Receptor, ErbB-2/analysis , Survival AnalysisABSTRACT
El absceso del psoas (ileopsoas) es un padecimiento raro, que evoluciona clínicamente en forma insidiosa e inespecifica; su diagnóstico y terapéutica tardíos aumentan su mortalidad. En más de 50 por ciento de los casos la causa primaria son los gérmenes gramnegativos y anaerobios. Las causas secundarias son tuberculosis extrapulmonar, metástasis al psoas abscedadas, y en dos de nuestros casos en diabetes mellitus y lupus eritematoso sistémico. Los principales datos son: fiebre de origen no determinado, dolor en flancos, tumoración de flancos, o fosa iliaca, limitación funcional de extremidades inferiores, leucocitosis significativa. En la placa radiográfica se advierte rectificación de la sombra de psoas y se aprecian imágenes hipoecoicas e hipodensas en el psoas, por ultrasonido y tomografía axial computada de abdomen. El tratamiento combinado con antimicrobianos de amplio espectro y el drenaje quirúrgico oportuno, extraperitoneal por humbotomía evita complicaciones graves, como falla organica múltiple