RESUMO
PURPOSE: While the overall prognosis of non-molecularly selected advanced non-small cell lung cancer (NSCLC) patients is poor, a subset of these patients has durable survival. We examined which clinical factors might be predictive for this favourable outcome. PATIENTS AND METHODS: Long-term NSCLC survivors (LTS, i.e. >2 years) were retrieved from all our out- and in-patient contacts in a 6 month period (March-August 2009). LTS records were compared with a group of short-term survivors (STS). Both baseline clinical factors (sex, age, smoking status, weight loss, performance status, co-morbidity, histological subtype, place and number of metastasis) and treatment-related features (number and type of therapeutic lines, response, duration of treatment-free interval) were compared. RESULTS: 31 LTS were retrieved (stage IV patients with potentially radical treatment options, e.g. solitary brain or adrenal metastasis, were excluded), and compared with 34 STS. In the LTS group, median survival was 53 months, with 47% of patients alive at 5 years, in the STS patients this was 9.7 months, with 24% alive at 1-year. Baseline factors had little predictive value, but response to 1st line therapy (P = 0.0001), response duration (P = 0.009), and the number of systemic lines (P = 0.0023) were of importance. CONCLUSION: These data confirm the existence of LTS in patients with advanced NSCLC. There are very little clinical factors at the time of diagnosis that help to distinguish future LTS from STS patients. Factors related to the effect of 1st line treatment are important, and further prospects of patients achieving a 2-year survival are in general quite good.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
A 50-year-old patient with malignant pleural mesothelioma (epithelial subtype, clinically staged cT1bN0M0) underwent a combined modality treatment, including induction chemotherapy, followed by extrapleural pneumonectomy (EPP) and radical radiotherapy. After pathologic examination of the surgical specimen, a complete remission (pT0N0) was observed. The complete disappearance of solid tumour tissue after induction chemotherapy is a rarely observed and documented finding in the combined modality treatment of malignant pleural mesothelioma. The real prognostic value of the pathologic complete remission of a malignant pleural mesothelioma definitely needs to be further evaluated in a larger series of patients.
