Does postpneumonectomy empyema improve long-term survival for patients with lung cancer?

Postpneumonectomy empyema (PPE) is life-threatening morbidity that affects up to 10% of patients and carries a 9-13% mortality risk. Treatment can take a long time, and the prognosis is uncertain. Forty years ago, improved survival was reported among patients with lung cancer and pleural empyema compared to those with lung cancer and no empyema. Here we investigated this potential association among patients with PPE. The present study included 38 patients who underwent pneumonectomy between 1995-2007 (7 females, 31 males, median age of 62 years) and then developed PPE, which was treated with the accelerated treatment (AT) method. Thirty-five of these patients had been diagnosed with lung cancer (including one case of carcinoid with infiltration), of whom 31 were matched with 31 lung cancer patients who underwent uncomplicated pneumonectomy at the same center between 1997-2009. The two groups did not significantly differ regarding sex, age, histology, TNM, FEV1, major co-morbidities, or received neoadjuvant or adjuvant therapy. Thirty-five (92.1%) patients from the initial group were treated successfully and the 5- and 10-year survival rates were 69% and 51%, respectively. Comparison between the matched groups revealed longer survival rates in the empyema group (5-year, 70%; 10-year, 49%) compared to the group without empyema (5-year, 38%; 10-year, 18%). Compared to the group without empyema, the empyema group showed significantly longer survival for all-cause mortality (p=0.004) and a lower incidence of cancer-unrelated mortality (p=0.02). The two groups did not significantly differ with regard to cancer-related mortality (p=0.09). In conclusion, accelerated treatment is a safe and effective method for the treatment of pleural empyema after pneumonectomy. The presently achieved results indicate improvement in survival of lung cancer patients with PPE in comparison to lung cancer patients after uncomplicated pneumonectomy.

Iron levels, genes involved in iron metabolism and antioxidative processes and lung cancer incidence.

BACKGROUND: Lung cancer is the most common adult malignancy accounting for the largest proportion of cancer related deaths. Iron (Fe) is an essential trace element and is a component of several major metabolic pathways playing an important role in many physiological processes. In this study we evaluated the association between Fe concentration in serum, iron metabolism parameters and genetic variaton in 7 genes involved in iron metabolism and anti-oxidative processes with the incidence of lung cancer in Poland. MATERIALS AND METHODS: The study included 200 lung cancer patients and 200 matched healthy control subjects. We analyzed serum iron concentration and iron metabolism parameters (TIBC, UIBC, serum ferritin and transferrin saturation), and genotyped seven variants in seven genes: HFE, TFR1, HAMP, TF, SOD2, CAT and GPX1. RESULTS: Lung cancer patients compared to their matched controls had significantly higher mean serum iron level (p = 0.01), ferritin level (p = 0.007) and TIBC (p = 0.006). Analysis revealed that higher concentration of iron and ferritin (IVth quartile) compared to the lower concentration (Ist quartile) was associated with over 2-fold increased lung cancer incidence. We also found that higher transferrin saturation (p = 0.01) and lower TIBC (p<0.01) are associated with better survival of lung cancer patients. The analysis of polymorphisms in iron related genes did not reveal a significant difference between lung cancer patients and controls. However, rs10421768 in HAMP showed a borderline statistically significant correlation with lung cancer risk (OR = 2.83, p = 0.05). CONCLUSIONS: The results of this case control study indicate that higher body iron represented by higher Fe and ferritin levels may be associated with lung cancer incidence. Rs10421768 in HAMP may be associated with about 3-times higher lung cancer risk. Higher Fe body content may be associated with better survival of lung cancer patients.