Lung cancer: district active treatment rates affect survival.

STUDY OBJECTIVE: This study investigates variation in management and treatment of lung cancer patients and determines the impact of any variation in treatment on survival. DESIGN: A retrospective study of population based data held by the Northern & Yorkshire Cancer Registry and Information Service (NYCRIS), comparing active treatment rates for lung cancer with survival by districts. SETTING The then 17 districts in Yorkshire and South Humber, England. PATIENTS: 22 654 patients registered with lung cancer between 1986 and 1994 and followed up until end of 1996. RESULTS: The overall rates of active treatment (surgery, radiotherapy, and chemotherapy) varied between districts from 37% to 56%. One year survival (with 95% CI) was significantly better in the districts with highest rates of active treatment 23% (22% to 24%) compared with 19% (17% to 20%) for those with lowest treatment rates. Non-small cell lung cancer patients (55%) in the districts with highest active treatment rates had an age adjusted relative risk of death during the follow up period, relative to risk of death in the districts with the lower treatment rates of 0.88 (0.83 to 0.92). Clinically diagnosed patients (34%) had an age adjusted RR of 0.92 (0.86 to 0.96). RR in small cell cancer (11%) was not significant. CONCLUSION: This study has shown wide variations in the rates of active treatment for lung cancer patients within districts across one large region of England. Active treatment was strongly associated with improved survival, especially in non-small cell lung cancer.

Electrolyte homeostasis in urothelial neoplasia: the effects of amiloride.

OBJECTIVE: To investigate the effect of amiloride preincubation on the intracellular electrolyte levels in neoplastic and non-neoplastic urothelium. MATERIALS AND METHODS: Samples of papillary transitional cell carcinomas (grades 1 and 2) and non-neoplastic human urothelium were either frozen immediately or after pre-incubation with Krebs saline alone or with Krebs saline containing amiloride. The frozen samples were planed in a cryo-ultramicrotome and then examined by low temperature scanning electron microscopy. Intracellular electrolyte levels were measured using X-ray microanalysis. RESULTS: In the cells frozen immediately the ratios K+/Na+, K+/P and K+/Cl- were significantly increased in neoplastic compared with non-neoplastic urothelial cells (P < 0.001). This difference was also found in the cells pre-incubated with Krebs saline alone but was not present in the cells pre-incubated with amiloride. CONCLUSIONS: These results were consistent with the concept that activation of the amiloride-sensitive Na+/H+ membrane exchanger is a primary event in neoplasia.

Electrolyte levels in neoplastic and nonneoplastic human urothelium after ouabain treatment: X-ray microanalysis of bulk hydrated samples.

Samples of neoplastic and nonneoplastic human urothelium were immediately frozen, incubated in Krebs' saline and then frozen, or incubated in 10(-5) mol/L ouabain in Krebs' saline and then frozen. The frozen specimens were then planed in a cryoultramicrotome and examined by low-temperature scanning electron microscopy. X-Ray microanalysis was performed on the superficial urothelial cells. Neoplastic cells immediately frozen and those incubated in Krebs' saline had significantly higher K+/Na+, K+/P, and K+/Cl- ratios and lower Na+/P and Cl-/P ratios than nonneoplastic cells. Incubation in ouabain led to a fall in the K+/Na+, K+/P, and K+/Cl- ratios and a rise in the Na+/P and Na+/Cl- ratios in both neoplastic and non-neoplastic cells and effectively nullified the difference between them. These results are consistent with the concept that in neoplasia a primary event is stimulation of Na+/H+ exchange, which leads to secondary stimulation of the ouabain-sensitive Na+/K+ ATPase pump.