Non-Small Cell Lung Cancer (NSCLC) diagnosed at a younger age have patterns of care, responses to treatment, and outcomes not entirely clear. A particular feature includes more advanced stages at diagnosis. Our objective was to characterize these young patients with advanced disease and evaluate the impact of targeted therapies. Analyzing our cohort of 18,252 newly diagnosed NSCLC patients, we defined Young-age versus Norm-age based on the age distribution at the time of diagnosis. Stage-IV patients were investigated on their clinical information and outcomes; deaths were considered lung cancer-related. Primary outcome was overall survival (OS). Multivariate Cox models were built to evaluate independent prognostic factors in comparative age groups. We found 4,267 patients with stage-IV NSCLC (359 Young-age; 3,908 Norm-age). Young patients had predominance of females (52.6% vs. 43.3%, P = 0.001), never-smokers (43.2% vs. 14.8%, P < 0.001), and adenocarcinoma (73.5% vs. 62.5%, P < 0.001). Mean OS was 21.1 months in the Young and 15.1 months in Norm, respectively (P < 0.001). Young patients were more often treated with surgery (6.7% vs. 5.0%), chemotherapy (53.2% vs. 44.1%), and targeted therapy (10.6% vs. 5.7%). Molecular studies were assessed in patients when the mutation tests became clinically available (93 Young, 875 Norm) and revealed a critical role of targeted therapy in the improved survival of both age groups. Young patients with stage-IV NSCLC have a specific profile and benefit more when treated with surgery and targeted therapy. Molecular testing is critical in this population, where improved survival was identified. A more aggressive approach to this population needs to be considered.
Abstract Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-186.
Fifth AACR International Conference on Frontiers in Cancer Prevention Research, Nov 12-15, 2006
PR-17
Background. People who survive beyond five years after a lung cancer diagnosis have been referred to as long-term lung cancer (LTLC) survivors. There currently is limited information about the health status, health behaviors, and quality of life (QoL) of LTLC survivors. In our multiple-dimension study, comprehensive models were explored under a conceptual model of Wilson and Cleary (1) to capture the most important survival predictors. Our framework encompasses the following five dimensions: health and QoL (e.g., comorbid conditions and spiritual well-being), health-related behaviors (e.g., smoking status and physical activity level), disease and treatment related factors (e.g., adverse effects and disease recurrence), host related factors (e.g., genotypes of oxidative pathways), tumor related factors (e.g., histology and markers of cell proliferation and apoptosis), as well as demographic variables. Methods. We conducted a matched multivariate analysis to assess predictors for longer survival and better QoL. We sequentially modeled from each study dimension and then to higher order dimensions. LTLC survivors (n=150) were matched to patients who survived less than 2 years (n=150) by known survival predictors including age at diagnosis, gender, tumor cell type, TNM stage, and number of primary lung cancers. Results . Under disease dimension, patients with any progression or recurrence were almost 3 times more likely to die within 2 years than those without progression or recurrence; under treatment dimension, those who had surgery were only 33% as likely to die within 2 years as those without surgery; under physical functioning dimension, patients who reported being unable to do or could only do light work were at a 2.7-5.8 fold higher probability of dying within 2 years than those who were fully active; and under host susceptibility dimension, patients with a GSTM1 positive allele (indicative of a higher anti-oxidative function) were 4 times less likely to die within 2 years than those with a null type. Summary. In this initial analysis, we have shown the importance of all five dimensions, with varying magnitude. New knowledge gained from our study may help lung cancer survivors, their healthcare providers, and their caregivers by providing evidence for establishing clinical recommendations to enhance their long-term survival and health-related QoL. (This study is supported by NIH grants CA77118, CA80127, CA84354, and CA115857.) 1. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life: A conceptual model of patient outcomes. JAMA 1995; 273:59-65
Aims Pulmonary chondromas, which are rare cartilaginous neoplasms that often arise in the setting of Carney triad, are morphologically similar to pulmonary hamartomas, which are much more common. There is evidence that succinate dehydrogenase (SDH) deficiency drives neoplasia in patients with Carney triad, and SDHB immunohistochemistry can be used as a surrogate marker to detect SDH deficiency. The aim of this study was to investigate the utility of SDHB immunohistochemistry in distinguishing pulmonary chondromas from hamartomas. Methods and results Immunohistochemistry for SDHB (clone 21A11AE7) was performed on histological sections from six cases of pulmonary chondroma and 33 cases of pulmonary hamartoma. SDHB expression was retained in all 33 pulmonary hamartomas, and lost in the majority of evaluable chondromas (five of six). Of the five patients with chondromas showing SDHB loss, four had definitive Carney triad. Most patients with pulmonary hamartomas were older males with small solitary masses, whereas chondromas often presented as multiple masses in young females. Conclusion Loss of SDHB immunohistochemical expression can be useful for differentiating pulmonary chondromas from hamartomas, and potentially identifying patients with Carney triad.
Here we present a case of a 75-year-old man with an incidentally discovered anterior mediastinal mass, which on resection showed histologic features of both type A and micronodular thymoma with lymphoid stroma (MNT). MNT is a rare variant of thymoma with a characteristic appearance of distinct nodules of epithelial cells with few interspersed lymphocytes surrounded by abundant lymphoid stroma that lacks epithelial cells. We discuss features of this tumor and compare similar cases reported in the literature.
Le patrimoine d'affectation est issu de la doctrine allemande du XIXe siecle et a ete recemment consacre par le legislateur dans des hypotheses neanmoins limitees. Des lors se pose la question de son extension a l’ensemble du droit francais. Traditionnellement, le patrimoine d'affectation s’oppose a la theorie classique du patrimoine, mais celle-ci est remise en cause par le droit positif et peut etre refutee au plan dogmatique. Par ailleurs, le patrimoine d'affectation, generalement apprehende comme une masse de biens affectes a un but, est sujet a des incertitudes notionnelles. En realite, le patrimoine d'affectation est une universalite de droit mue par un but ou par un interet et caracterisee par la separation des patrimoines. Ainsi definie, il apparait que les patrimoines d'affectation nommes ne correspondent pas veritablement a la notion et qu’ils doivent etre modifies. En outre, le patrimoine d'affectation presente diverses utilites aussi bien en droit patrimonial de la famille qu’en droit des affaires, specialement en matiere de financements et de societes, et serait ainsi source d’efficacite economique du droit francais. Aussi, la reconnaissance generale du patrimoine d'affectation en droit positif s’impose.
