The Impact of Lung Carcinoma Histology on the Frequency of Bone Metastases.

Objective Lung cancer is the leading cause of death by cancer, and the bones are one of the most common sites of metastasis from this condition. This study aimed to evaluate the influence of lung carcinoma histology on the frequency of bone metastases. Methods This retrospective study evaluated the medical records of 407 patients diagnosed with lung cancer between 2003 and 2012. The prevalence of bone metastases and their association with histological subtypes were evaluated using chi-squared tests, odds ratios (ORs) and 95% confidence intervals (CIs). The overall survival was evaluated using the Kaplan-Meier method. Results The prevalence of bone metastases was 28.2% ( n = 115), and the spine was the most frequently affected site (98 metastases; 32.1%). Adenocarcinoma was the most common histological subtype of lung carcinoma (46.7%), and it was significantly more frequent among patients with bone metastases (58.3% versus 42.1%; p = 0.003; OR = 1.92; 95% CI: 1.29-2.97). Squamous cell carcinoma was significantly less frequent among patients with bone metastases (13.0% versus 29.8%; p = 0.0004; OR = 0.35; 95% CI: 0.19-0.64). The median survival time after the first bone metastasis diagnosis was 4 months. Conclusion Adenocarcinoma was the most common histological subtype of lung carcinoma, and it was significantly associated with a higher risk of developing bone metastases.

The Impact of Lung Carcinoma Histology on the Frequency of Bone Metastases / O impacto da histologia do carcinoma pulmonar na frequência das metástases ósseas

Abstract Objective Lung cancer is the leading cause of death by cancer, and the bones are one of the most common sites of metastasis from this condition. This study aimed to evaluate the influence of lung carcinoma histology on the frequency of bone metastases. Methods This retrospective study evaluated the medical records of 407 patients diagnosed with lung cancer between 2003 and 2012. The prevalence of bone metastases and their association with histological subtypes were evaluated using chi-squared tests, odds ratios (ORs) and 95% confidence intervals (CIs). The overall survival was evaluated using the Kaplan-Meier method. Results The prevalence of bone metastases was 28.2% (n = 115), and the spine was the most frequently affected site (98 metastases; 32.1%). Adenocarcinoma was the most common histological subtype of lung carcinoma (46.7%), and it was significantly more frequent among patients with bone metastases (58.3% versus 42.1%; p = 0.003; OR = 1.92; 95% CI: 1.29-2.97). Squamous cell carcinoma was significantly less frequent among patients with bone metastases (13.0% versus 29.8%; p = 0.0004; OR = 0.35; 95% CI: 0.19-0.64). The median survival time after the first bone metastasis diagnosis was 4 months. Conclusion Adenocarcinoma was the most common histological subtype of lung carcinoma, and it was significantly associated with a higher risk of developing bone metastases.

Resumo Objetivo O câncer de pulmão é a principal causa de morte por neoplasia, e os ossos são os principais locais de metástases desse tipo de câncer. O objetivo deste estudo foi avaliar a influência do tipo histológico do carcinoma de pulmão na frequência das metástases ósseas. Métodos Foram avaliados retrospectivamente os registros médicos de 407 pacientes diagnosticados com câncer de pulmão entre 2003 e 2012. A prevalência de metástases ósseas e suas associações com os subtipos histológicos foram avaliadas com o teste qui-quadrado, razão de probabilidade (RP), e intervalos de confiança (IC) de 95%. A sobrevida global foi avaliada com o método de Kaplan-Meier. Resultados A prevalência das metástases ósseas foi de 28,2% (n = 115), e a coluna vertebral foi o local mais frequente (98 metástases: 32,1%). O adenocarcinoma foi o subtipo histológico mais comum de carcinoma pulmonar (46,7%) e foi significativamente mais frequente entre os pacientes com metástases ósseas (13,0% versus 29,8%; p = 0,0004; OR = 0,35; 95% IC: 0,19-0,64). O tempo médio de sobrevida após o diagnóstico da primeira metástase óssea foi de 4 meses. Conclusão O adenocarcinoma foi o subtipo histológico mais comum de carcinoma pulmonar e foi significativamente associado a um maior risco de desenvolvimento de metástases ósseas.

Pathological fractures due to bone metastases from lung cancer: risk factors and survival / Fratura patológica devido à metástase óssea do câncer de pulmão: fatores de risco e sobrevida

ABSTRACT Introduction: Pathological fractures are frequent skeletal-related events among lung cancer patients, which result in high morbidity and decreased overall survival and make operative treatment decisions challenging. Objectives: To identify risk factors associated with the occurrence of pathological fractures in patients with lung cancer and to determine survival. Methods: We conducted a retrospective cohort study with 407 lung carcinoma patients diagnosed between 2006 and 2015. The prevalence of bone metastases and pathological fractures was calculated. Statistical analysis was conducted using a chi-squared test, and the odds ratio and 95% confidence interval were calculated. Overall survival was determined using the Kaplan-Meier method and differences were compared using the log-rank test. Results: The prevalence of bone metastases and pathological fractures was 28.2% (n = 115) and 19.1% (n = 22), respectively. Pathological fractures were more frequent among patients with bone metastases at the time of diagnosis of lung cancer (24.7% [n = 20] vs. 5.9% [n = 2]; p < 0.05). The median overall survival following the diagnosis of lung cancer, bone metastases, and pathological fracture was 6, 4, and 2 months, respectively. Conclusions: Pathological fracture was associated with synchronous bone metastases and overall survival times were considerably reduced. Level of Evidence IV, Case Series.

RESUMO Introdução: Fratura patológica é um evento esquelético frequente em pacientes com câncer de pulmão, resultando em alta morbidade e sobrevida global reduzida que torna a decisão de tratamento cirúrgico desafiadora. Objetivos: Identificar fatores de risco associados à ocorrência de fraturas patológicas em pacientes com câncer de pulmão e determinar a sobrevida. Métodos: Conduzimos um estudo retrospectivo de coorte com 407 pacientes diagnosticados com carcinoma pulmonar entre 2006 e 2015. A prevalência de metástase óssea e fratura patológica foi calculada. Análise estatística foi conduzida usando o teste X2, e razão de chances e o intervalo de confiança de 95% foi calculado. A sobrevida global foi determinada usando o método de Kaplan-Meier e as diferenças foram comparadas usando o teste do log-rank. Resultados: A prevalência de metástases ósseas e fraturas patológicas foi de 28,2% (n = 115) e 19,1% (n = 22), respectivamente. Fraturas patológicas foram mais frequentes em pacientes com metástases ósseas ao diagnóstico do câncer de pulmão (24,7 % [n = 20] vs. 5,9% [n = 2]; p < 0.05). A sobrevida global média após o diagnóstico do câncer de pulmão, da metástase óssea e da fratura patológica foram 6, 4 e 2 meses, respectivamente. Conclusão: Fratura patológica foi associada à metástase óssea sincrônica e a sobrevida global consideravelmente reduzida. Nível de Evidência IV. Série de Casos.

PERCUTANEOUS TREATMENT OF ANEURYSMAL BONE CYST WITH CALCITONIN AND METHYLPREDNISOLONE.

OBJECTIVE: To introduce the intralesional calcitonin and methylprednisolone percutaneous injection method, which results in the promotion of primary aneurysmal bone cyst (ABC) healing. METHODS: A retrospective cohort study involving 76 patients diagnosed with ABC was performed between 2005 and 2014. Patients treated with calcitonin and methylprednisolone injection and who underwent more than 2 years of follow-up were considered eligible for the study (n=47). The Enneking staging and Capanna classification systems were used during the initial evaluation. Treatment response was assessed by Rastogi radiographic grading based on the degree of healing. X2 and Wilcoxon signed-rank tests and odds ratio calculations were used in the statistical analysis with a 5% significance level. RESULTS: The proximal tibia extremity was the most commonly affected site (17.0%). Thirty-three (70.3%) ABC cases were staged as B3 and 28 (59.7%) were classified as type II. The average number of injections performed was 2.8 per patient, with an average reduction of the initial lytic area of 83.7% (p-value=0.00001). Satisfactory results for 91.4% (n=43; p-value=0.00001) were obtained and 5 recurrences occurred. No side effects were observed. CONCLUSION: Intralesional calcitonin and methylprednisolone percutaneous injection is a minimally invasive, effective, and safe method for promoting primary ABC healing. Level of evidence IV, Type of study: case series.

OBJETIVO: Apresentar o método de injeção intralesional percutânea de calcitonina e metilprednisolona para promover a ossificação do cisto ósseo aneurismático (COA). MÉTODOS: Foi realizado um estudo retrospectivo de coorte envolvendo 76 pacientes com diagnóstico de COA entre 2005 e 2014. Os pacientes tratados com injeção de calcitonina e metilprednisolona e acompanhados durante mais de dois anos foram considerados elegíveis para o estudo (n = 47). Foram utilizados o sistema de estadiamento de Enneking e a classificação de Capanna durante a avaliação inicial. A resposta ao tratamento foi avaliada pela classificação radiográfica Rastogi, com base no grau de cicatrização. Os testes X2, Wilcoxon e o cálculo da razão de chances foram utilizados na análise estatística com nível de significância de 5%. RESULTADOS: A extremidade proximal da tíbia foi o local mais frequente (17,0%). Trinta e três (70,3%) COA eram B3 e 28 (59,7%) do tipo II. O número médio de injeções aplicadas foi de 2,8 por paciente, com redução média da área lítica inicial de 83,7% (p = 0,00001). Resultados satisfatórios para 91,4% (n = 43; p = 0,00001) dos pacientes e houve cinco recidivas. Nenhum efeito colateral foi observado. CONCLUSÃO: A injeção intralesional percutânea de calcitonina e metilprednisolona é um método minimamente invasivo, eficaz e seguro para promover a ossificação do COA. Nível de evidência IV, Tipo de estudo: série de casos.

Percutaneous treatment of aneurysmal bone cyst with calcitonin and methylprednisolone / Tratamento percutâneo de cisto ósseo aneurismático com calcitonina e metilprednisolona

ABSTRACT Objective: To introduce the intralesional calcitonin and methylprednisolone percutaneous injection method, which results in the promotion of primary aneurysmal bone cyst (ABC) healing. Methods: A retrospective cohort study involving 76 patients diagnosed with ABC was performed between 2005 and 2014. Patients treated with calcitonin and methylprednisolone injection and who underwent more than 2 years of follow-up were considered eligible for the study (n=47). The Enneking staging and Capanna classification systems were used during the initial evaluation. Treatment response was assessed by Rastogi radiographic grading based on the degree of healing. X2 and Wilcoxon signed-rank tests and odds ratio calculations were used in the statistical analysis with a 5% significance level. Results: The proximal tibia extremity was the most commonly affected site (17.0%). Thirty-three (70.3%) ABC cases were staged as B3 and 28 (59.7%) were classified as type II. The average number of injections performed was 2.8 per patient, with an average reduction of the initial lytic area of 83.7% (p-value=0.00001). Satisfactory results for 91.4% (n=43; p-value=0.00001) were obtained and 5 recurrences occurred. No side effects were observed. Conclusion: Intralesional calcitonin and methylprednisolone percutaneous injection is a minimally invasive, effective, and safe method for promoting primary ABC healing. Level of evidence IV, Type of study: case series.

RESUMO Objetivo: Apresentar o método de injeção intralesional percutânea de calcitonina e metilprednisolona para promover a ossificação do cisto ósseo aneurismático (COA). Métodos: Foi realizado um estudo retrospectivo de coorte envolvendo 76 pacientes com diagnóstico de COA entre 2005 e 2014. Os pacientes tratados com injeção de calcitonina e metilprednisolona e acompanhados durante mais de dois anos foram considerados elegíveis para o estudo (n = 47). Foram utilizados o sistema de estadiamento de Enneking e a classificação de Capanna durante a avaliação inicial. A resposta ao tratamento foi avaliada pela classificação radiográfica Rastogi, com base no grau de cicatrização. Os testes X2, Wilcoxon e o cálculo da razão de chances foram utilizados na análise estatística com nível de significância de 5%. Resultados: A extremidade proximal da tíbia foi o local mais frequente (17,0%). Trinta e três (70,3%) COA eram B3 e 28 (59,7%) do tipo II. O número médio de injeções aplicadas foi de 2,8 por paciente, com redução média da área lítica inicial de 83,7% (p = 0,00001). Resultados satisfatórios para 91,4% (n = 43; p = 0,00001) dos pacientes e houve cinco recidivas. Nenhum efeito colateral foi observado. Conclusão: A injeção intralesional percutânea de calcitonina e metilprednisolona é um método minimamente invasivo, eficaz e seguro para promover a ossificação do COA. Nível de evidência IV, Tipo de estudo: série de casos.

PATHOLOGICAL FRACTURES DUE TO BONE METASTASES FROM LUNG CANCER: RISK FACTORS AND SURVIVAL.

INTRODUCTION: Pathological fractures are frequent skeletal-related events among lung cancer patients, which result in high morbidity and decreased overall survival and make operative treatment decisions challenging. OBJECTIVES: To identify risk factors associated with the occurrence of pathological fractures in patients with lung cancer and to determine survival. METHODS: We conducted a retrospective cohort study with 407 lung carcinoma patients diagnosed between 2006 and 2015. The prevalence of bone metastases and pathological fractures was calculated. Statistical analysis was conducted using a chi-squared test, and the odds ratio and 95% confidence interval were calculated. Overall survival was determined using the Kaplan-Meier method and differences were compared using the log-rank test. RESULTS: The prevalence of bone metastases and pathological fractures was 28.2% (n = 115) and 19.1% (n = 22), respectively. Pathological fractures were more frequent among patients with bone metastases at the time of diagnosis of lung cancer (24.7% [n = 20] vs. 5.9% [n = 2]; p < 0.05). The median overall survival following the diagnosis of lung cancer, bone metastases, and pathological fracture was 6, 4, and 2 months, respectively. CONCLUSIONS: Pathological fracture was associated with synchronous bone metastases and overall survival times were considerably reduced. Level of Evidence IV, Case Series.

INTRODUÇÃO: Fratura patológica é um evento esquelético frequente em pacientes com câncer de pulmão, resultando em alta morbidade e sobrevida global reduzida que torna a decisão de tratamento cirúrgico desafiadora. OBJETIVOS: Identificar fatores de risco associados à ocorrência de fraturas patológicas em pacientes com câncer de pulmão e determinar a sobrevida. MÉTODOS: Conduzimos um estudo retrospectivo de coorte com 407 pacientes diagnosticados com carcinoma pulmonar entre 2006 e 2015. A prevalência de metástase óssea e fratura patológica foi calculada. Análise estatística foi conduzida usando o teste X2, e razão de chances e o intervalo de confiança de 95% foi calculado. A sobrevida global foi determinada usando o método de Kaplan-Meier e as diferenças foram comparadas usando o teste do log-rank. RESULTADOS: A prevalência de metástases ósseas e fraturas patológicas foi de 28,2% (n = 115) e 19,1% (n = 22), respectivamente. Fraturas patológicas foram mais frequentes em pacientes com metástases ósseas ao diagnóstico do câncer de pulmão (24,7 % [n = 20] vs. 5,9% [n = 2]; p < 0.05). A sobrevida global média após o diagnóstico do câncer de pulmão, da metástase óssea e da fratura patológica foram 6, 4 e 2 meses, respectivamente. CONCLUSÃO: Fratura patológica foi associada à metástase óssea sincrônica e a sobrevida global consideravelmente reduzida. Nível de Evidência IV. Série de Casos.

The relationship between lung cancer histology and the clinicopathological characteristics of bone metastases.

OBJECTIVES: Lung cancer is the leading cause of death due to cancer, and bone is one of the most frequent sites of metastasis. However, there is no published evidence regarding an association between lung cancer histology and skeletal complications. Therefore, we evaluated the influence of lung cancer histology on the frequency of bone metastases (BMs), skeletal-related events (SREs), and survival after BM. MATERIAL AND METHODS: This retrospective study evaluated medical records from 413 patients who were diagnosed with lung cancer between 2003 and 2012. The prevalences of BMs and SREs were calculated, and their associations with the histological subtypes were evaluated using the chi-square test, odds ratios (OR), and 95% confidence intervals (CI). Overall survivals and associations with the histological subtypes were evaluated using the Kaplan-Meier method and the log-rank test. RESULTS: The prevalences of BM, synchronous BM, and SREs were 28.2%, 70.4%, and 68.7%, respectively. Adenocarcinoma was the most common histological subtype (46.7%), and was significantly more frequent among patients with BM (58.3% vs. 42.1%; p=0.003; OR: 1.92; 95% CI: 1.29-2.97). Squamous cell was significantly less frequent among patients with BM (13.0% vs. 29.8%; p=0.0004; OR: 0.35; 95% CI: 0.19-0.64). The median survival time after the first BM diagnosis was 4 months, and there was no significant difference in the survival periods for the various histological subtypes. CONCLUSION: Adenocarcinoma and squamous cell were significantly associated with higher and lower risks of developing BM, respectively.

Heparanase expression and localization in different types of human lung cancer.

BACKGROUND: Heparanase is the only known mammalian glycosidase capable of cleaving heparan sulfate chains. The expression of this enzyme has been associated with tumor development because of its ability to degrade extracellular matrix and promote cell invasion. METHODS: We analyzed heparanase expression in lung cancer samples to understand lung tumor progression and malignancy. Of the samples from 37 patients, there were 14 adenocarcinomas, 13 squamous cell carcinomas, 5 large cell carcinomas, and 5 small cell carcinomas. Immunohistochemistry was performed to ascertain the expression and localization of heparanase. RESULTS: All of the tumor types expressed heparanase, which was predominantly localized within the cytoplasm and nucleus. Significant enzyme expression was also observed in cells within the tumor microenvironment, such as fibroblasts, epithelial cells, and inflammatory cells. Adenocarcinomas exhibited the strongest heparanase staining intensity and the most widespread heparanase distribution. Squamous cell carcinomas, large cell carcinomas, and small cell carcinomas had a similar subcellular distribution of heparanase to adenocarcinomas but the distribution was less widespread. Heparanase expression tended to correlate with tumor node metastasis (TNM) staging in non-small cell lung carcinoma. CONCLUSION: In this study, we showed that heparanase was localized to the cytoplasm and nucleus of tumor cells and to cells within the microenvironment in different types of lung cancer. This enzyme exhibited a differential distribution based on the type of lung tumor. General significance Elucidating the heparanase expression patterns in different types of lung cancer increased our understanding of the crucial role of heparanase in lung cancer biology. This article is part of a Special Issue entitled Matrix-mediated cell behaviour and properties.

Expression of ABC transporters, p53, Bax, Bcl-2 in an archival sample of non-small cell lung cancer bearing a deletion in the EGFR gene.

EGFR mutations have been correlated to responsiveness to treatment with tyrosine kinase inhibitors. These drugs are themselves substrates for ABC transporters. In the present work we describe the immunohistochemical profile of an archival sample from a male Brazilian patient with no Asian ancestry and never smoker, diagnosed with non-small cell lung cancer. This tumor was found to contain an in-frame hemi- or homozygous deletion, E746-A750 in exon 19 of the EGFR gene. Immunohistochemistry revealed a relatively weak staining for the ABC transporter subfamily ABCC1 and strongly for ABCB1. The cytoplasm stained positively for Bax and the nucleus stained for p53, but was negative for Bcl-2. Antibody against acetylated lysine revealed staining in both, cytoplasm and nucleus of tumor cells in contrast to normal cells which were essentially negative. The overall immunohistochemistry pattern obtained for this sample indicates that the del E746-A750 mutation may have down-regulated the expression of ABCC1. The results also suggest that the NSCLC analyzed displayed a transcriptionally active chromatin as judged by the results obtained with the anti-acetylated lysine antibody.

Brazilian version of the QLQ-LC13 lung cancer module of the European Organization for Research and Treatment of Cancer: preliminary reliability and validity report.

This study reports the reliability and validity of the Brazilian Portuguese version of QLQ-LC13. After translation and cross-cultural adaptation, the questionnaire was administered, together with the QLQ-C30 core questionnaire, to 82 patients with lung cancer. The analysis was based on 60 patients who completed two interviews, and who received chemotherapy alone or in combination with radiotherapy. The reliability or internal consistency of dyspnea scale was 0.79. The pain scale needed to be combined with the QLQ-C30 pain items to reach a satisfactory value of 0.73. The construct validity was supported by the ability of the questionnaire to discriminate patients regarding their performance status and type of treatment. However, the change over time, although in the expected direction for all items, was statistically significant in four of the 10 items studied. The criterion-related validity was supported by the statistically significant correlation between all four side effect items and the physicians' reports of toxicity, while the evolutive changes in the performance status were statistically significant in only four items. Most psychometric properties of the Brazilian version of the QLQ-LC13 were adequately supported in this analysis. However, a wider utilization of this module is necessary to fully ascertain its reliability and validity properties.

Marcadores moleculares no câncer de pulmão: papel prognóstico e sua relação com o tabagismo / Molecular markers in lung cancer: prognostic role and relationship to smoking

Estudos epidemiológicos têm demonstrado um nexo causal entre tabagismo e carcinoma de pulmão. Embora a maioria dos cânceres de pulmão esteja associada com tabagismo, somente uma minoria de grandes tabagistas desenvolve essa malignidade, o que leva ao conceito de que fatores genéticos afetam a susceptibilidade individual. As principais alterações moleculares no câncer de pulmão são: genes de supressão tumoral, proto-oncogenes e fatores de crescimento, atividade da telomerase e status de metilação de promotores. Fatores estimuladores da angiogênese (fator de crescimento endotelial vascular) e fatores relacionados à proliferação e apoptose de células tumorais (receptor para fator de crescimento epidérmico, p53, K-ras, retinoblastoma, BCL-2) são bem conhecidos. Vários desses fatores genéticos foram investigados, porém nenhum deles apresentou seletividade no que diz respeito à importância prognóstica ou eficácia terapêutica. Estratégias terapêuticas para o tratamento do câncer de pulmão devem considerar essas alterações genéticas precoces para promover o seu reparo ou eliminar as células tumorais.

Molecular markers in lung cancer: prognostic role and relationship to smoking.

Epidemiological studies have demonstrated a causal relationship between smoking and lung cancer. Although most lung cancer cases are linked to smoking, only a minority of heavy smokers develop lung cancer, leading to the notion that genetic factors affect individual susceptibility. The principal molecular changes in lung cancer are seen in tumor suppressor genes, proto-oncogenes, growth factors, telomerase activity, and methylation status of promoters. Well-known agents include angiogenesis-stimulating factors (such as vascular endothelial growth factor), as well as factors related to tumor cell proliferation and apoptosis (epidermal growth factor receptor, p53, K-ras, retinoblastoma and BCL-2). Several of these genetic factors have already been investigated, but no single parameter has yet presented sufficient selectivity regarding prognostic value or therapeutic efficacy. Treatment strategies to cure lung cancer should focus on these early genetic lesions in order to promote their repair or to eliminate these lung cancer cells.

Tumor de Pancoast e carcinoma gástrico primários e sincrônicos / Synchronous primary Pancoast tumor and gastric cancer

Os autores descrevem um caso raro de tumores malignos, primários e sincrônicos de sítios pulmonar e gástrico, sendo o primeiro com apresentação clínico-radiológica de tumor de Pancoast. O uso de citoqueratinas foi utilizado para se certificar de que os tumores eram primários, excluindo-se, assim, neoplasia metastática pulmonar de etiologia gástrica. Os autores realizam breve revisão da literatura

Differential proteomic serum pattern of low molecular weight proteins expressed by adenocarcinoma lung cancer patients.

Based on the assumption that proteins can emanate from tumour to serum, we investigated whether serum low molecular weight proteins (LMW) can discriminate lung cancer patients from healthy donors. Pooled sera from 20 lung cancer patients matched in sex (men), histological type (adenocarcinoma) and stage (IIIB and IV) and from 20 healthy donors (men) were submitted to 2-DE coupled to MALDI-TOF peptide mass fingerprinting. Results of 2D-E/ MALDI-TOF showed five up regulated proteins (immunoglobulin lambda chain, transthyretin monomer, haptoglobin-alfa 2 and two isoforms of serum amyloid protein) and one down regulated (fragment of apolipoprotein A-I) in patients. All differentially expressed proteins, except immunoglobulin, may be acting as a non-specific sign of inflammation in cancer and transthyretin monomer may act as a possible blood marker to CSF barrier disruption that occurs, e.g., in cerebral metastasis. In conclusion, this work shows the usefulness of 2D-gel electrophoresis and mass spectrometry proteomic techniques for the identification of up- and down-regulated proteins in serum from adenocarcinoma lung cancer patients.

Serum protein profiling of lung cancer patients.

Lung cancer is one of the leading causes of cancer deaths worldwide. The poor patients prognosis is largely attributable to the lack of effective early detection methods. Based on the concept that proteins and peptides can emanate from tumor to the serum, the present study aims to investigate if serum proteins pattern, assessed by a gradient polyacrylamide gel, is capable to discriminate 66 lung cancer patients from 44 healthy donors. Additionally, in a group of 10 patients and 10 healthy donors, it was also investigated by western-blot if apoptosis and metastasis-related proteins such as Bax, Bcl-2 and Hlm were present in serum. Our results showed that, in patients, protein bands of 180 kDa and 13 kDa were more frequent (Fisher, P<0.05) and a protein band of 124 kDa was more intense (Mann Whitney, P<0.05). In healthy donors a band of 158 kDa were more frequent (Fisher, P<0.05), a band of 24 kDa was more intense (Mann Whitney, P<0.05) and bands of 14 kDa and 9 kDa were together more frequent (Fisher, P<0.05) and intense (Mann Whitney, P<0.05). Bax, Bcl-2 and Hlm were not detected in serum. We conclude that changes in serum protein pattern of lung cancer patients can be detected by a simple methodology.

Correlação entre a radiologia tóracica e a broncofibroscopia em pacientes com suspeita de Câncer de pulmão. Análise de 67 exames. / Correlation between the thoracic radiolofy and fiberoptic bronchoscopy in patients with suspected lung cancer. Analysis of 67 procedures.

Introdução: a broncofibroscopia (BFC), a tomografia computadorizada (TC) e a teleradiografia de tórax (Rx) são métodos complementares de investigação no câncer de pulmão (CP). A identificação de anormalidades radiológicas como atelectasia ou massa pulmonar precedendo a realização da BFC parecem aumentar a curácica diagnóstica da BCF. O objetivo deste estudo foi avaliar a correlação entre radiologia torácica e o rendimento diagnóstico da BFC no CP em um Hospital Universitário no Rio de Janeiro. Métodos: Foram avaliados retrospectivamente os prontuários de pacientes cuja indicação do exame havia sido suspeita de câncer de pulmão, submetidos à BFC no período entre 1º Janeiro de 2001 e 31 de Março de 2002. Os autores descrevem as anormalidades radiológicas mais comumente associadas ao diagnóstico de CP. Resultados: 67 pacientes (48 homens) foram estudados, com uma média de idade de 64 anos (44 a 87 anos). A BFC Teve o seu maior rendimento diagnóstico entre os pacientes com massa pulmonar ao Rx (58%, 38/67) e com lesão visível à endoscopia (84%, 56/57). A correlação entre radiologia e diagnóstico broncoscópico de CP foi de 90% (60/67). Conclusão: BFC e a radiologia são métodos complementares usados na investigação de pacientes de CP. O Rx e a TC de tórax são úteis na suspeita de câncer de pulmão, com excelentes correlação entre a suspeita de doenças na radiologia e a visualização direta na BFC.

Introduction: fiberoptic bronchoscopy (FB), thoracic computed tomography (CT) and chest radiograph are complementary methods of investigating patients with lung cancer (LC). Chest radiographic abnormalities such as pulmonary mass or atelectasis prior to FB have been shown diagnostic value in a attempt to increase the diagnostic yield of the FB. The aim of this study was to evaluate the correlation between thoracic radiology and bronchoscopic for the LC diagnosis in a Universitary Hospital in Rio de Janeiro. Methods: medical charts of patients who underwent FB from January 1, 2001 to March, 31, 2002 because lung cancer suspected were evaluted. The authors describe the most frequent radiographics abnormalities related to the LC diagnosis suspected. Results: 67 patients (48 men) were studied with a mean age of 64 years (range 44-87). FB had higher diagnostic yield among patients with pulmonary mass on the chest radiograph (58%, 38/65) and visible lesion on endoscopy (84%, 56/67). The correlation between radiology and bronchoscopic diagnosis of LC was 90% (60/67). Conclusion: FB and radiology are complementary methods used in the investigation of patients with suspicion of LC. Chest radiographs and CT had been shown to be of value prior to FB in the investigation of malignancy, with excellent correlation between the detection of diase on radiology and direct visualisation at FB.

Rendimento diagnóstico da broncofibroscopia no diagnóstico do câncer de pulmão: análise de 84 exames / Diagnostic yield of fiberoptic bronchoscopy in the diagnosis of lung cancer: analysis of 84 procedures

Introdução: a broncofibroscopia (BFC) é o principal método diagóstico do câncer de pulmão (CP). O objetivo deste estudo foi avaliar o rendimento da BFC no diagnóstico do CP. Métodos: foram restrospectivamente estudados os prontuários de pacientes com suspeita clínica de CP, submetidos a BFC, no período de 1° de Janeiro de 2001 a 31 de Março de 2002, em um hospital universitário terciário. O rendimento da BFC foi avaliado em 3 grupos, de acordo com o resultado obtido ao exame endoscópico: presença de lesão visível, ausência de lesão visível e sinais indiretos de lesão brônquica. Resultados: foram estudados os prontuários de 84 pacientes (62 homens), com média de idade de 55,4 anos (variando de 32-83 anos). O diagnóstico definitivo foi estabelecido através da BFC em 80%dos casos (67/84). O maior rendimento da BFC ocorreu na presença de lesão visível (91%, 58/64), com a biópsia obtendo o diagnóstico em 75% (48/65) dos casos, o lavado brônquico e/ou broncoalveolar em 39% (33/84) e escovando brônquico em 31%; 26/84). O carcinoma escamoso foi o tipo histológico mais frequente (38%; 32/84), seguido do adenocarcinoma (31%; 26/84). Ocorreram complicações em 8% (7/84) dos casos e em somente 2% (2/84) dos pacientes foi necessário interromper o exame por sangramento. Conclusões: a BFC apresenta bom rendimento diagnóstico no CP, sendo os tipos histológicos mais frequente o carcinoma escamoso e o adenocarcinoma.

Introduction: Fiberoptic bronchoscopy (FB) is an excellent method to investigated patients with suspicion of lung cancer (LC). The aim of this manuscript was to evaluate the yield of bronchoscopy for LC in a Universitary Hospital In Rio de Janeiro. Methods: charts of patients underwent to a bronchoscopy from January 1, 2001 to March, 31, 2002 in a University Hospital were retrospectively evaluated. The authors decribe the yield of FB in 3 groups: presence of visible lesion on endoscopy, absence of visible lesion and indirect findings. Results: 84 patients (62 men) were studied with a mean age of 55.4 years (range 32-83 years). A diagnosis was established by FB in 67 (80%, 67/84). Higher yields (90.6%) were found among patients with visible lesion on endoscopy (58/64). Biopsy specimens provided a positived result in 75% (49/65), bronchial washing in 39% (33/84), and bronchial brushing in 31% (10/32). Highest yields were seen in squamous cell lung center cancer (38%, 32/84). Complications were low (8%, 7/84) and severe bleeding leading to interruption of the procedure was associated only with bronchial brushing in 2% (2/84). Conclusions: FB reached a reasonable yield in the diagnosis of LC and most prevalent histological type were squamous cell lung center and adenocarcinoma.

Marcadores tumorais no câncer de pulmão: um caminho para a terapia biológica / Tumor markers in lung cancer: a pathway to biological therapy

Os avanços recentes na genética e na biologia molecular permitiram a identificação de genes e proteínas produzidos ou superexpressados pelos tumores. Tais produtos, os chamados marcadores tumorais, antes utilizados apenas como ferramentas de diagnóstico e prognóstico, vêm atualmente tomando papel importante no desenvolvimento de novas modalidades de tratamento, direcionadas a quebrar o ciclo biológico da progressão tumoral. Neste artigo, revisa-se o papel de alguns marcadores tumorais tradicionalmente conhecidos (CEA, p53, NSE, K-ras), e descrevem-se a prevalência e a função da superexpressão do receptor do fator de crescimento epidérmico (EGFR) e do seu produto protéico (p185neu). Novos agentes têm sido desenvolvidos baseando-se no bloqueio da sinalização iniciada pelo EGFR. Destes, destaca-se o ZD1839 (Iressa), uma droga via oral que inibe de modo reversível e seletivo a atividade tirosina-quinase do EGFR, e que vem demonstrando bons resultados tanto isoladamente quanto em combinação com outros agentes quimioterápicos. Tais avanços devem contribuir de modo significativo no tratamento do câncer, principalmente no carcinoma de pulmão do tipo não-pequenas células