Prognostic Value of Stage Grouping and TNM Descriptors in Lung Cancer

Buccheri, Gianfranco; Ferrigno, Domenico

doi:10.1378/chest.117.5.1247

Cited by 35 publications

(15 citation statements)

References 33 publications

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“…In these models, we opted to include T (primary tumor) and N (regional lymph nodes) categories as independent covariables, given that TNM descriptors have proved to be very informative in clinical research. 15 To take into account differences between hospitals due to unmeasured conditions, confidence intervals and p-values were computed using robust methods, considering patients clustered into hospitals. 16 The proportionality assumption was evaluated plotting the corresponding cumulative functions (H t ) against time in a log-scale, and also checking the statistical significance of an interaction between each of the markers and the time dependent variable log (t).…”

Section: Discussionmentioning

confidence: 99%

Clinical value of p53, c‐erbB‐2, CEA and CA125 regarding relapse, metastasis and death in resectable non‐small cell lung cancer

Pollán

Varela²,

Torres

et al. 2003

Intl Journal of Cancer

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The prognostic value of p53 and c-erbB-2 immunostaining and preoperative serum levels of CEA and CA125 was investigated in a prospective multicentric study including 465 consecutive non-small cell lung cancer (NSCLC) patients with resectable tumors. Four end-points were used: lung cancer death, first relapse (either locoregional or metastasis), locoregional recurrence and metastasis development. Standard statistical survival methods (Kaplan-Meier and Cox regression) were used. The specificity of the prognostic effect across different types of tumors was also explored, as had been planned in advance. Our results showed, once again, that pathological T and N classifications continue to be the strongest predictors regarding either relapse or mortality. Three of the studied markers seemed to add further useful information, however, but in a more specific context. For example, increased CEA concentration defined a higher risk population among adenocarcinomas but not among people with squamous tumors; and p53 overexpression implied a worse prognosis mainly in patients with well differentiated tumors. The analysis of type of relapse proved to be very informative. Thus, CA125 level was associated with a worse prognosis mainly related with metastasis development. Another interesting result was the influence of smoking, which showed a clear dose-response relationship with the probability of metastasis. For future studies, we recommend the inclusion of different endpoints, namely considering the relationship of markers with the type of relapse involved in lungcancer recurrence. They can add useful information regarding the complex nature of prognosis. Prognosis for non-small cell lung cancer (NSCLC) has remained disappointing over the last decades, even in localized stages that are amenable to curative surgery. 1 Recurrence rates among patients with resectable NSCLC are substantial, 2-4 and only around 50% of them will be alive after 5 years. 5 The clinical or pathologic TNM staging (T, primary tumor; N, regional lymph nodes; M, distant metastasis) does not always provide a satisfactory explanation for differences in relapse and survival. It is of major importance, however, to be able to anticipate a bad prognosis to prescribe an active chemotherapy or radiotherapy adjuvant program. 6,7 In this context, a large number of articles have been published proposing the incorporation of different prognostic markers in clinical practice, 8 but the interpretation and integration of their results is hampered by methodological problems. Many studies included a low number of patients, and very few examined more than 1 or 2 markers. Furthermore, the majority are retrospective cohorts, where the quality of the follow-up is uncertain and the possibility of a selection bias cannot be ruled out. 9 Prognostic studies try to identify one or more variables that might be useful to classify a heterogeneous population into smaller subgroups with more predictable outcomes. This classification will serve to apply therapy more efficiently, avoiding...

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Section: Discussionmentioning

confidence: 99%

Clinical value of p53, c‐erbB‐2, CEA and CA125 regarding relapse, metastasis and death in resectable non‐small cell lung cancer

Pollán

Varela²,

Torres

et al. 2003

Intl Journal of Cancer

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“…The pathological diagnosis of primary lung cancer was in accordance with the revised World Health Organization (WHO) classification of lung tumours [11] and included 496 squamous cell carcinomas, 293 adenocarcinomas, 144 small cell carcinomas, 82 large cell carcinomas and 262 unclassified anaplastic cancers (table 1). All patients were classified according to the 1997 staging system [12], either retrospectively [13] or prospectively. Pre-treatment clinical evaluation was based on clinical tests and examinations, and remained mostly unchanged during the study.…”

Section: Patientsmentioning

confidence: 99%

Lung cancer: clinical presentation and specialist referral time

Buccheri

Ferrigno²

2004

European Respiratory Journal

125

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Many textbooks describe symptoms and signs of lung cancer but refer to old series of patients.To update knowledge about lung cancer presentation, a study was carried out on 1,277 consecutive lung cancer patients, who were seen in a single Institution from January 1989 to October 2002. A set of 33 anthropometric, clinical, physical, laboratory, radiological, pathological and follow-up variables was prospectively recorded for all patients. In addition, information was obtained concerning symptoms of alarm (i.e. potential concern), times to specialist referral and the mix of symptoms at presentation. Patients were carefully followed-up and their subsequent clinical course was recorded.Casual discovery with absence of symptoms occurred more frequently towards the end of the study period and the prevalence of chest pain became less common. No other time-dependent changes were found in the presenting symptoms. Delay in specialist referral was longer when presentation was provoked by cough or by the occurrence of systemic symptoms, such as weight loss, anorexia and asthenia. Referral delay was longer towards the end of the study, perhaps related to an increase in the number of elderly patients with co-morbidities. Both alarm and prevalence symptoms were strong predictors of the clinical outcome, as found in both univariate analysis (favourable: casual discovery and chest infection; unfavourable: chest pain, dyspnoea, systemic symptoms and symptoms of local or systemic dissemination) and in multivariate analysis (favourable: chest infection).Early presentation of lung cancer is characterised by a specific symptomatic pattern. Knowledge of this pattern may help to improve the rate of early diagnosis.

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“…19 The lung tumors included 296 squamous cell carcinomas, 210 adenocarcinomas, and 93 small cell carcinomas (the other, less common pathologic diagnoses are listed in Table 1). All patients were classified according to the 1997 International System for Staging Lung Carcinoma, 20 either retrospectively 21 or prospectively. Pretreatment clinical evaluation was based on a few clinical tests and examinations and mostly remained unchanged during the decade of study.…”

Section: Patientsmentioning

confidence: 99%

“…Details of the treatment protocols used during the last decade, including the type and scheme of cytostatic drugs, have been reported already. 21 The survival period was recorded from the time of histologic diagnosis to the date of death or to the closure of the study (December 2001). The status of the patient (i.e., deceased or living) was verified by a telephone contact with the patient (if living) or with the family, physician, or the municipal office of the registry.…”

Section: Patientsmentioning

confidence: 99%

Plasma levels of D‐dimer in lung carcinoma

Buccheri

Torchio

Ferrigno

2003

Cancer

Self Cite

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BACKGROUNDThe activation of the clotting‐fibrinolytic system in cancer patients is common and represents an unfavorable clinical sign. D‐dimer (DD) is a sensitive marker of fibrinolysis.METHODSThe current study comprised 826 new lung carcinoma patients seen consecutively in a single institution over a 10‐year period (1992–2001). For each patient, 31 variables, including DD and survival duration, were available for analysis.RESULTSOnly weak relationships between DD and the other variables were found. The DD variable correlated best with the level of lactate dehydrogenase, performance status, tissue polypeptide antigen, stage of disease, and the number of metastases (rho = 0.33, −0.25, 0.18, 0.18, and 0.15, respectively). The D‐dimer distinguished patients with different prognoses. The median survival periods were 154 days (95% confidence interval [CI], 122–189 days) and 308 days (95% CI, 227–409 days; log rank statistic, 26.56; P < 0.01), respectively, for abnormally elevated and normal values. The difference was greater in patients with adenocarcinoma and in patients presenting with a less advanced disease, especially in patients with pathologic Stage Ia disease. The best multivariate survival model selected 10 significant covariates, including DD.CONCLUSIONSThe authors recommend measuring the plasma level of DD in all new lung carcinoma patients. This measurement may help to formulate individual prognoses and can be used to indicate adjuvant treatment for surgical patients. Cancer 2003;97:3044–52. © 2003 American Cancer Society.DOI 10.1002/cncr.11432

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Prognostic Value of Stage Grouping and TNM Descriptors in Lung Cancer

Cited by 35 publications

References 33 publications

Clinical value of p53, c‐erbB‐2, CEA and CA125 regarding relapse, metastasis and death in resectable non‐small cell lung cancer

Clinical value of p53, c‐erbB‐2, CEA and CA125 regarding relapse, metastasis and death in resectable non‐small cell lung cancer

Lung cancer: clinical presentation and specialist referral time

Plasma levels of D‐dimer in lung carcinoma

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