Prognostic factors of lung cancer in lymphoma survivors (the LuCiLyS study).

BACKGROUND: Second cancer is the leading cause of death in lymphoma survivors, with lung cancer representing the most common solid tumor. Limited information exists about the treatment and prognosis of second lung cancer following lymphoma. Herein, we evaluated the outcome and prognostic factors of Lung Cancer in Lymphoma Survivors (the LuCiLyS study) to improve the patient selection for lung cancer treatment. METHODS: This is a retrospective multicentre study including consecutive patients treated for lymphoma disease that subsequently developed non-small cell lung cancer (NSCLC). Data regarding lymphoma including age, symptoms, histology, disease stage, treatment received and lymphoma status at the time of lung cancer diagnosis, and data on lung carcinoma as age, smoking history, latency from lymphoma, symptoms, histology, disease stage, treatment received, and survival were evaluated to identify the significant prognostic factors for overall survival. RESULTS: Our study population included 164 patients, 145 of which underwent lung cancer resection. The median overall survival was 63 (range, 58-85) months, and the 5-year survival rate 54%. At univariable analysis no-active lymphoma (HR: 2.19; P=0.0152); early lymphoma stage (HR: 1.95; P=0.01); adenocarcinoma histology (HR: 0.59; P=0.0421); early lung cancer stage (HR: 3.18; P<0.0001); incidental diagnosis of lung cancer (HR: 1.71; P<0.0001); and lung cancer resection (HR: 2.79; P<0.0001) were favorable prognostic factors. At multivariable analysis, no-active lymphoma (HR: 2.68; P=0.004); early lung cancer stage (HR: 2.37; P<0.0001); incidental diagnosis of lung cancer (HR: 2.00; P<0.0001); and lung cancer resection (HR: 2.07; P<0.0001) remained favorable prognostic factors. Patients with non-active lymphoma (n=146) versus those with active lymphoma (n=18) at lung cancer diagnosis presented better median survival (64 vs. 37 months; HR: 2.4; P=0.02), but median lung cancer specific survival showed no significant difference (27 vs. 19 months; HR: 0.3; P=0.17). CONCLUSIONS: The presence and/or a history of lymphoma should not be a contraindication to resection of lung cancer. Inclusion of lymphoma survivors in a lung cancer-screening program may lead to early detection of lung cancer, and improve the survival.

Spontaneous Pneumomediastinum After Electronic Cigarette Use.

Spontaneous pneumomediastinum is an uncommon condition typically occurring in young men presenting with pleuritic pain, dyspnea, and subcutaneous emphysema. We report an exceptional case of spontaneous pneumomediastinum after electronic cigarette use in an otherwise healthy young man.

Inability to perform maximal stair climbing test before lung resection: a propensity score analysis on early outcome.

OBJECTIVE: The objective of the present study was to assess whether patients unable to perform a preoperative maximal stair climbing test had an increased incidence of morbidity and mortality after major lung resection compared to patients who were able to exercise. METHODS: Three hundred and ninety one patients submitted to pulmonary lobectomy or pneumonectomy for lung cancer were analyzed. Forty-five of these patients were unable to perform a preoperative maximal stair climbing test for underlying comorbidities. Unadjusted and propensity score case matched comparisons were performed between patients who could and who could not perform a preoperative stair climbing test. Multi-variable analyses were then performed to identify predictors of morbidity and mortality, and were validated by bootstrap bagging. RESULTS: Patients who could not perform the stair climbing test had similar morbidity rates (31.1 vs. 35.6%, respectively, P=0.7), but higher mortality rates (15.6 vs. 4.4%, respectively, P=0.08) and deaths among complicated patients (50 vs. 12.5%, respectively, P=0.025), compared to propensity score matched patients who could perform the stair climbing test. Logistic regression analyses showed that the inability to perform the stair climbing test was an independent and reliable predictor of mortality (P=0.005) but not of morbidity (P=0.2). CONCLUSIONS: Patients unable to perform a preoperative maximal exercise test had an increased risk of mortality after major lung resection. Half of these patients did not survive postoperative complications, due to their decreased aerobic reserve caused by physical inactivity which made them unable to cope with the increased oxygen demand.

How to distinguish an active air leak from a pleural space effect.

AIM: We aimed to distinguish a pleural space effect from an active air leak, using a digital chest drain system that provided continuous air flow and pleural pressure checks. METHODS: between March 2010 and October 2011, we employed 144 digital drains for 138 thoracic surgical procedures. RESULTS: We observed 18 (12.5%) active air leaks, among which 4 (2.8%) were prolonged air leaks characterized by high differential pleural pressure due to increased mean expiratory pressure (>1 cm H(2)O; p<0.0001), and 3 (2.1%) late air leaks, all long-lasting (p<0.0001), predicted by pressure curve divergence before the air flow appearance. We also reported 25 (17.4%) pleural space effects characterized by a high differential pleural pressure, but mainly due to a lower mean inspiratory pressure (<20 cm H(2)O; p<0.0001), and especially related to surgical pleurodesis procedures (p<0.0003) and wide lung resections (p<0.0002); there was no increasing pneumothorax after provocative clamping. CONCLUSIONS: A digital chest drain system, ensuring continuous air flow and pleural pressure measurement, could clearly identify a pleural space effect, avoiding the frequent misinterpretation of an active air leak, and allowing safe removal of the chest tube at the right time.

A model to predict the decline of the forced expiratory volume in one second and the carbon monoxide lung diffusion capacity early after major lung resection.

The objective of the study was to develop regression models for the prediction of the decline of the forced expiratory volume in one second (FEV1) and the carbon monoxide lung diffusion capacity (DLCO) early after major lung resection. One hundred and ninety patients submitted to pulmonary lobectomy or pneumonectomy for lung cancer performed preoperative and early postoperative (mean 10.9 after operation) pulmonary function tests. One hundred and fifty of these patients also underwent DLCO measurements by the single breath method. The decline of FEV1 and DLCO were expressed as percentage losses from preoperative values. Stepwise multiple regression analyses were performed to develop two models estimating the percent reduction of FEV1 and DLCO from preoperative values. The multivariate procedures were then validated by bootstrap analyses. The following regression equations were derived: estimated percent reduction in FEV1 = 21.34 - (0.47 x age) + (0.49 x percentage of functioning parenchyma removed during operation) + (17.91 x COPD-index); estimated percent reduction in DLCO = 35.99 - (0.31 x age) - (36.47 x FEV1/FVC ratio) + (0.33 x DLCO) + (0.54 x percentage of functioning parenchyma removed during operation). The comparison between observed and estimated losses of FEV1 and DLCO (by using these regression equations) was not significantly different. We think the regression models generated in this study may be reliably used for risk stratification purposes.