Risk factors for early mortality from lung cancer: evolution over the last 20 years in the French nationwide KBP cohorts.

BACKGROUND: The impact of the most recent advances, including targeted therapies and immune checkpoint inhibitors, on early (3-month) mortality in lung cancer is unknown. The aims of this study were to evaluate the real-world rate of and risk factors for early mortality, as well as trends in early mortality over the last 20 years. MATERIALS AND METHODS: The KBP prospective observational multicenter studies have been conducted every 10 years since 2000. These studies collect data on all newly diagnosed patients with lung cancer (all stages and histologies) over 1 year in non-academic public hospital pulmonology or oncology units in France. In this study, we analyzed data on patient and tumor characteristics from participants in the KBP-2020 cohort and compared the characteristics of patients who died within 3 months of diagnosis with those of all other patients within the cohort. We also carried out a comparative analysis with the KBP-2000 and KBP-2010 cohorts. RESULTS: Overall, 8999 patients from 82 centers were included in the KBP-2020 cohort. Three-month survival data were available for 8827 patients, of whom 1792 (20.3%) had died. Risk factors for early mortality were: male sex, age >70 years, symptomatic disease at diagnosis, ever smoker, weight loss >10 kg, poor Eastern Cooperative Oncology Group performance status (≥1), large-cell carcinoma or not otherwise specified, and stage ≥IIIC disease. The overall 3-month mortality rate was found to have decreased significantly over the last 20 years, from 24.7% in KBP-2000 to 23.4% in KBP-2010 and 20.3% in KBP-2020 (P < 0.0001). CONCLUSION: Early mortality among patients with lung cancer has significantly decreased over the last 20 years which may reflect recent improvements in treatments. However, early mortality remained extremely high in 2020, particularly when viewed in light of improvements in longer-term survival. Delays in lung cancer diagnosis and management could contribute to this finding.

Chronic bronchiolitis in ankylosing spondylitis.

The pleuro-pulmonary signs of ankylosing spondylitis are generally asymptomatic, typically represented by biapical lung fibrosis. To our knowledge, the severe bronchiolitis which is sometimes observed in other spondyloarthropathies has not been described in ankylosing spondylitis. We report two cases of severe chronic bronchiolitis in ankylosing spondylitis patients. Their clinical and radiological presentation were similar, characterized by progressive deterioration of stage III-IV dyspnea, non-reversible obstructive ventilatory defect, and CT scan showing air trapping with mosaic attenuation and ground-glass opacity in expiration. Lung biopsies confirmed the diagnosis of severe follicular bronchiolitis in one patient and constrictive bronchiolitis is suspected in the other. Only the patient with follicular bronchiolitis responded positively to treatment with low doses of macrolides.

Phagocytosis-promoting activity of avian plasma and fibroblastic cell surface fibronectins.

The purpose of this investigation was to determine whether fibronectin preparations from both chicken plasma and cell surface of fibroblasts can promote phagocytosis of gelatin-coated latex particles. Chicken plasma fibronectin was isolated (a) by ammonium sulfate fractionation, chromatography on Sepharose-4B followed by purification on a Sepharose-4B-heparin column; (b) by affinity chromatography on a Sepharose-4B-rat-antifibronectin column; (c) by affinity chromatography on Sepharose-4B-gelatin followed by molecular sieve separation on Sepharose-CL4B; (d) by a dual affinity chromatographic method using a Sepharose-4B-gelatin column and a Sepharose-4B-heparin column. Chicken cell surface fibronectin from fibroblast cultures was purified by ammonium sulfate precipitation followed by chromatography on Sepharose-CL4B. The purity of preparations was examined by polyacrylamide gel electrophoresis in the presence of sodium dodecylsulfate; all samples showing high purity. The opsonic activities of the preparations were measured by the uptake of 125I-labeled gelatin coated latex particles in conjunction with rat liver slice, and peritoneal macrophage monolayer systems. Both the plasma fibronectin and cell surface fibronectin preparations showed substantial opsonic activities in the test systems. Fresh chicken plasma did not reveal any phagocytosis promoting activity due to the presence of some unidentified inhibitor(s). The results showed that an opsonically active protein can be isolated from chicken plasma or serum and this protein is identical to plasma fibronectin. Furthermore, it could be concluded that cell surface fibronectin from chicken fibroblasts also can serve as an opsonin for gelatin coated particles.