Prognostic impact of paraneoplastic cushing's syndrome in small-cell lung cancer.
J Thorac Oncol
; 9(4): 497-505, 2014 Apr.
Article
em En
| MEDLINE
| ID: mdl-24736072
ABSTRACT
INTRODUCTION:
Paraneoplastic Cushing's syndrome (CushingPS) in small-cell lung cancer is rare but severe.METHODS:
We studied 383 patients with small-cell lung cancer diagnosed between 1998 and 2012. Among them, 23 patients had CushingPS, 56 had other paraneoplastic syndrome (OtherPS), and 304 had no paraneoplastic syndrome (NoPS).RESULTS:
After comparison of the three groups, we observed that CushingPS patients had more extensive disease 82.6% versus 67.8% versus 53.3% (p = 0.005), respectively, with more than two metastatic sites 63.2% versus 15.8% and 24.1% (p ≤ 0.001), a higher World Health Organization performance status (2-4) 73.9% versus 57.1% versus 43.7% (p = 0.006), greater weight loss (≥10%) 47.8% versus 33.9% versus 16.4% (p ≤ 0.001), reduced objective response to first-line treatment 47.6% versus 74.1% versus 71.1% (p = 0.04), and poorer sensitivity to first-line treatment 19% versus 38.9% versus 48.6% (p = 0.01). NoPS patients, with World Health Organization performance status of 3-4, had extensive disease at diagnosis, with response, sensitivity to first-line treatment, and survival similar to the CushingPS group. At relapse, the CushingPS group had no objective response to second-line treatment versus 25% versus 42.8% in OtherPS and NoPS groups, respectively (p = 0.005). The median survival of CushingPS patients was 6.6 months versus 9.2 months for OtherPS and 13.1 months for NoPS patients (p ≤ 0.001). CushingPS is a prognostic factor of death (hazard ratio, 2.31; p ≤ 0.001).CONCLUSION:
CushingPS is the worst form of the paraneoplastic syndromes with particularly extensive tumors. Reduced objective response and sensitivity to first-line treatment and no response to second-line treatment suggest starting palliative care early at first line and exclusively at relapse.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Síndromes Paraneoplásicas
/
Síndrome de Cushing
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Carcinoma de Pequenas Células do Pulmão
/
Neoplasias Pulmonares
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Thorac Oncol
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
França