Understanding clinical practice and survival outcomes in patients with unresectable stage III non-small-cell lung cancer in a single centre in Quebec.

Methods: A retrospective cohort study considered patients 18 or more years of age diagnosed between January 2007 and May 2018 with unresectable stage iii non-small-cell lung cancer (nsclc) who received combined chemoradiation (crt). Survival was analyzed using the Kaplan-Meier method to determine median overall (os) and progression-free survival (pfs) and the associated 95% confidence intervals (cis). Cox regression analysis was performed to identify factors prognostic for survival, including age, sex, smoking status, Eastern Cooperative Oncology Group performance status (ecog ps), histology, treatment type, tumour size, and nodal status. Results: Of 226 patients diagnosed with unresectable stage iii disease, 134 (59%) received combined crt. Mean age was 63 years; most patients were white, were current smokers, had an ecog ps of 0 or 1, and had nonsquamous histology. Median pfs was 7.03 months (95% ci: 5.6 months to 8.5 months), and os for the cohort was 18.7 months (95% ci: 12.4 months to 24.8 months). Of those patients, 78% would have been eligible for durvalumab consolidation therapy. Univariate analysis demonstrated a significant os benefit (p = 0.010) for concurrent crt (ccrt) compared with sequential crt (scrt). Disease-specific survival remained significantly better in the ccrt group (p = 0.004). No difference in pfs was found between the ccrt and scrt groups. In addition, tumour size and nodal involvement were significant discriminating factors for survival (p < 0.05). In this patient cohort, 64% of patients progressed and received subsequent therapy. Based on multivariate analysis, tumour size and nodal station were the only factors predictive of survival in patients with unresectable stage iii nsclc treated with crt. Conclusions: Combined crt has been the standard treatment for unresectable stage iii nsclc. In our study, a trend of better survival was seen for ccrt compared with scrt. Factors predictive of survival in patients with stage iii disease treated with crt were tumour size and nodal station. Most patients with stage iii disease would potentially be eligible for durvalumab maintenance therapy based on the eligibility criteria from the pacific trial. The use and effectiveness of novel treatments will have to be further studied in our real-world patient population and similar populations elsewhere.

Absence of estrogen receptors in dysplastic nevi and malignant melanoma.

Benign nevi, dysplastic nevi, and primary and metastatic malignant melanomas were evaluated for the presence of sex hormone binding and estrogen receptor protein. We have confirmed the observation of Ellis et al. that some pigmented lesions possess sex hormone-binding proteins. We could not demonstrate a true estrogen receptor in any benign nevi, dysplastic nevi, primary melanomas, or metastatic melanomas. Thus the ability to bind estrogen or progesterone does not correlate with the presence of a true estrogen receptor. Lack of nuclear estrogen receptors suggests that the influence of estrogen on the pathophysiology of melanoma or of benign melanocytic nevi may not be significant.

The response of articular cartilage to weight-bearing against metal. A study of hemiarthroplasty of the hip in the dog.

Hemiarthroplasty of the hip and some other joints has been used for many years with satisfactory results, but the fate of articular cartilage when weight-bearing against metal has not been reported. Replacement of the head of the femur was carried out in one hip of each of 26 dogs, and the changes in acetabular cartilage studied at intervals of up to 24 weeks. There was early loss of proteoglycan, followed by surface damage to the cartilage, progressive degenerative changes, and growth of pannus from the articular margins. At 24 weeks after operation there was little remaining articular cartilage, while intense subchondral activity suggested that the bony skeleton was being remodelled to conform to the shape of the prosthesis. This study is not intended to suggest that hemiarthroplasty does not help patients.

Zonal analysis of cytoplasmic steroid hormone receptor levels: replication and synthetic activity in embryonic calf growth cartilage.

Using the dextran charcoal method, a specific steroid receptor for dexamethasone, but not 17 beta-estradiol or 17 alpha-methyltrienolone, was demonstrated in cytosol prepared from mid-gestation fetal calf growth cartilage. Zonal analysis of cytoplasmic receptor levels showed that tissue sections from the center, the peripheral surface, and the palisade section bound 229 +/- 111, 173 +/- 64, and 15 +/- 28 femtomole dexamethasone per mg of protein, respectively. Incorporation of 3H-thymidine, 35S-sulfate, and 3H-proline into cartilaginous tissues was used as an index of replication and synthetic activity. The percentage of 3H-thymidine labeled nuclei, as determined by radioautography, showed that the palisade zone has a significantly lower replicating activity (P less than 0.001). Values were 5.6 +/- 1.2, 5.4 +/- 1.2, 3.8 +/- 1.3, and 1.1 +/- 0.2 for the center, peripheral surface, and upper and lower half of the palisade section. The rate of sulfate and proline incorporation into the palisade zone was over seven times higher than the central and peripheral surface (P less than 0.001). The difference in the rate of matrix synthesis and proliferating activity in these regions may be related to the zonal heterogeneity of receptor levels of glucocorticoids in fetal growth cartilage.