Top PDF THROMBOCYTOSIS AS PROGNOSTIC FACTOR FOR SURVIVAL IN PATIENTS WITH ADVANCED NON SMALL CELL LUNG CANCER TREATED WITH FIRST- LINE CHEMOTHERAPY.

THROMBOCYTOSIS AS PROGNOSTIC FACTOR FOR SURVIVAL IN PATIENTS WITH ADVANCED NON SMALL CELL LUNG CANCER TREATED WITH FIRST- LINE CHEMOTHERAPY.

THROMBOCYTOSIS AS PROGNOSTIC FACTOR FOR SURVIVAL IN PATIENTS WITH ADVANCED NON SMALL CELL LUNG CANCER TREATED WITH FIRST- LINE CHEMOTHERAPY.

The prevalence of thrombocytosis did not differ sig- nificantly between ages, sex and histology. On the contrary, in the present study we identified significant association between elevated platelet counts and advanced stage, worse PS and weight loss more than 10% for three months. Univariate analysis revealed that OS was shorter in patients with thrombocytosis than in patients without it. On multivariate analysis thrombocytosis remained a significant prognostic factor. Although thrombocytosis is associated with other risk factors, pretreatment platelet count predicts poorer survival in patients with advanced NSCLC. These results are with agreement with previous published find- ings. High circulating levels of platelets are found in pa- tients with metastatic disease and have been related to ex- tensive disease and poor prognosis in patients with NSCLC [11]. Tomita et al. described that the preoperative platelet count was a prognostic factor for resectable NSCLC pa- tients. The 5- year survival probabilities of patients with normal or elevated platelet counts were reported as 26,87% and 63,73%, respectively [23]. Pedersen et al. reported that patients with elevated platelet counts had a significantly poorer survival rate than those with normal platelet counts (p< 0, 0001) [11].
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Quantification of cell-free mSHOX2 Plasma DNA for therapy monitoring in advanced stage non-small cell (NSCLC) and small-cell lung cancer (SCLC) patients.

Quantification of cell-free mSHOX2 Plasma DNA for therapy monitoring in advanced stage non-small cell (NSCLC) and small-cell lung cancer (SCLC) patients.

Due to more powerful drugs [23] and the introduction of a targeted therapy for molecularly selected patient subgroups like patients with an EGFR activation mutation, impressive im- provements in the treatment of lung cancer patients were achieved [24]. Additionally, more effective maintenance regimens have shown beneficial effects for patients with advanced stage NSCLC. There is also a survival advantage for patients who are treated with second-line che- motherapy as compared to best supportive care and clinical trials testing new combinations in the second line setting for refractory disease were initiated [25][26]. In order to select the best treatment options, a rapid, specific and sensitive method for the assessment of a therapy re- sponse is of crucial importance. The standard procedure for advanced stage lung cancer pa- tients after induction therapy is a CT scan to evaluate the tumor response [21]. Apart from the costs, the sensitivity of this imaging technique is not very high and the inter-observer vari- ability in the measurement of the tumor size is prone to misinterpretation of tumor response [27].
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The Efficacy and Safety of Icotinib in Patients with Advanced Non-Small Cell Lung Cancer Previously Treated with Chemotherapy: A Single-Arm, Multi-Center, Prospective Study.

The Efficacy and Safety of Icotinib in Patients with Advanced Non-Small Cell Lung Cancer Previously Treated with Chemotherapy: A Single-Arm, Multi-Center, Prospective Study.

Current therapy for second-line and multiple-line setting included single docetaxel, peme- trexed, erlotinib and gefitinib. Chemotherapies provided an ORR of 6.3–7.6% and a PFS around 2.0–2.7 months.[8,9] EGFR TKIs, such as gefitinib and erlotinib, merited similar out- come benefits to chemotherapy with a PFS of 2.2 months in overall population, and a PFS around 3.0–3.4 months in Asian population.[7–9] The phase 4 Tarceva Lung Cancer Survival Treatment (TRUST) study recruited a total of 6,665 patients worldwide, with 1,242 patients recruited within the East/Southeast (E/SE) Asian region.[17,18] The median PFS for the E/SE Asian population was 5.78 months, compared with 2.92 months for the non-E/SE Asian popu- lation and 3.25 months for the overall global population. As a subgroup of Asian patients, 519 Chinese patients were enrolled. Of these patients, one case had complete response, 127 cases had partial response, 263 cases had stable disease, and 88 cases had progressive disease, result- ing in a 26.7% ORR and a 75.3% DCR. The median TTP was 6.44 months, and median OS was 15.37 months. [17]
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The Hemoglobin Level as a Prognostic Factor in Patients with Non-Small Cell Lung Cancer  Treated with Gemcitabine and cis-Platinum

The Hemoglobin Level as a Prognostic Factor in Patients with Non-Small Cell Lung Cancer Treated with Gemcitabine and cis-Platinum

Anemia is a common finding in cancer patients. Up to 30% of patients with different types of tumors have been reported to suffer from anemia (6). This can be related to the disease process itself or to its treatment, whether it is chemotherapy or radiotherapy. The factors associated with anemia itself encompass disorders of iron metabolism (7), reduced numbers of erythroid progenitor cells in the bone marrow, increased levels of inflammatory cytokines (8), extracorpuscular hemolysis, catabolism of patients with tumor burden, and relative deficiency of erythropoietin (6). Generally, the anemia is considered within the category of anemia of chronic diseases as normocytic and normochromic (7). The association of decreased hemoglobin levels with decreased survival has been demonstrated by randomized, controlled trials and large, community- based studies (9).
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Analysis of Prognostic Factors in 541 Female Patients with Advanced Non-small Cell Lung Cancer

Analysis of Prognostic Factors in 541 Female Patients with Advanced Non-small Cell Lung Cancer

【Abstract】 Background and objective As there is a sharp increase in the incidence of lung cancer in women in re- cent years, it has brought broad concerns with its unique clinical and epidemiological characteristics and beter prognosis. he aim of this study is to analyze the clinical data of women with advanced non-small cell lung cancer (NSCLC) retrospectively to explore the prognostic factors. Methods Clinical data of 541 female patients with advanced NSCLC were collected and fol- lowed up till death. he primary endpoint is overall survival (OS). SPSS 11.0 statistical analysis sotware was used for univariate and multivariate analysis. Results he mean age is 59 years (20 years-86 years), adenocarcinoma account for 80.2% (434/541). he median OS was 15 months (95%CI: 13.87-16.13), and 1, 2, 5-year survival rates were 58.8%, 23.7% and 3.20% respective- ly. Univariate analysis showed that clinical stage, ECOG score, weight loss, clinical symptoms, liver/bone/brain metastasis and received more than one chemotherapy regimen, good response to the irst-line chemotherapy, EGFR-TKI targeted therapy and radiotherapy treatment were signiicantly correlated with the OS and survival rate (P<0.05). Combined with multivariate anal- ysis, weight loss before treatment, ECOG score, received EGFR-TKI targeted therapy and response to irst-line chemotherapy were independent prognostic factor for survival (P<0.05). Conclusion here is a higher percentage of adenocarcinoma in fe- male NSCLC. Weight loss before treatment, ECOG score, EGFR-TKI targeted therapy and response to irst-line chemotherapy may become independent prognostic factors for survival of female patients with advanced NSCLC.
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Association of TERT Polymorphisms with Clinical Outcome of Non-Small Cell Lung Cancer Patients.

Association of TERT Polymorphisms with Clinical Outcome of Non-Small Cell Lung Cancer Patients.

In survival analyses, we observed the polymorphism rs2736109 significantly associated with PFS of advanced NSCLC patients receiving first-line platinum-based chemotherapy. The effect of the polymorphism was also apparent in subgroup of > 58 years old, male, ever smokers, never smokers, stage IV, histologic type of squamous cell, cisplatin-navelbine and carboplatin-paclitaxel regimens. The polymorphism rs2736109 is located in the putative pro- moter region of TERT. Interestingly, functional annotation indicates that rs2736109 is locat- ed in the binding site of GATA-2 transcription factor and the variant A allele creates a new GATA-1 binding site compared with the wild-type G allele according to TFSEARCH predic- tion (http://www.cbrc.jp/research/db/TFSEARCH.html), implying its potential impact on transcription factor binding activity and TERT expression. Further functional and mechanis- tic studies will be required to clarify the real role of this genetic variant. In this study, we did not observe any association between TERT polymorphisms and OS. OS as an endpoint of cancer treatment is clinically meaningful and objectively assessed, with limitations of con- founding effects of post-protocol events, for example, subsequent therapies. Since we focused on first-line treatment in the current study, we believed PFS, with greater statistical power and a lower likelihood of confounding by subsequent therapies, is more suitable for our re- search than OS [34–36].
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Rev. bras. epidemiol.  vol.17 número4

Rev. bras. epidemiol. vol.17 número4

ABSTRACT: Introduction: Outcomes data on Non-Small Cell Lung Cancer (NSCLC) are scarce with regard to the private health care in Brazil. The aim of this study was to describe the characteristics, treatments performed, and the survival of patients with NSCLC in a Brazilian private oncologic institution. Methods: Medical charts from patients treated between 1998 and 2010 were reviewed, and data were transferred to a clinical research form. Long-term follow-up and survival estimates were enabled through active surveillance. Results: Five hundred sixty-six patients were included, and median age was 65 years. Most patients were diagnosed in advanced stages (79.6% III/IV). The overall survival was 19.0 months (95%CI 16.2 – 21.8). The median survival was 99.7, 32.5, 20.2, and 13.3 months for stages I, II, III, and IV, respectively (p < 0.0001). Among patients receiving palliative chemotherapy, the median survival was 12.2 months (95%CI 10.0 – 14.4). Conclusions: The outcomes described are favorably similar to the current literature from developed countries. Besides the better access to health care in the private insurance scenario, most patients are still diagnosed in late stages. Keywords: Lung neoplasms. Epidemiology. Supplemental health. Neoplasm staging. Survival analysis. Treatment.
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SINGLE AGENT DOCETAXEL AS SECOND- LINE CHEMOTHERAPY FOR PRETREATED PATIENTS WITH RECURRENT NON- SMALL CELL LUNG CANCER

SINGLE AGENT DOCETAXEL AS SECOND- LINE CHEMOTHERAPY FOR PRETREATED PATIENTS WITH RECURRENT NON- SMALL CELL LUNG CANCER

Objective: Single agent Docetaxel is a standard therapy for patients with non- small cell lung cancer after the failure of platinum- containing regimens. The aim of this study was to explore the efficacy and safety of Docetaxel monotherapy as second- line chemotherapy in pretreated patient with inoperable non- small cell lung cancer. Methods: From January 2005 to May 2008 thirty- six consecutive patients with locally advanced or metastatic morphologically proven stage IIIB/ IV non- small cell lung cancer entered the study after failure of previous platinum- based regimens. Treatment schedule consist of Docetaxel 75 mg/m2 administered every three weeks with repetition after 21 days with Dexamethasone premedication. Results: Overall response rate, median time to progression and median survival was 16,6 %, 4,5 months and 5,6 months respectively. The main hematological toxicity was neutropenia. Conclusions: That data suggest that single agent Docetaxel remain reasonable choices for the chemotherapy in pretreated patients with non- small cell lung cancer.
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BRCA1: a novel prognostic factor in resected non-small-cell lung cancer.

BRCA1: a novel prognostic factor in resected non-small-cell lung cancer.

Background. Although early-stage non-small-cell lung cancer (NSCLC) is considered a potentially curable disease following complete resection, patients have a wide spectrum of survival according to stage (IB, II, IIIA). Within each stage, gene expression profiles can identify patients with a higher risk of recurrence. We hypothesized that altered mRNA expression in nine genes could help to predict disease outcome: excision repair cross-complementing 1 (ERCC1), myeloid zinc finger 1 (MZF1) and Twist1 (which regulate N-cadherin expression), ribonucleotide reductase subunit M1 (RRM1), thioredoxin-1 (TRX1), tyrosyl- DNA phosphodiesterase (Tdp1), nuclear factor of activated T cells (NFAT), BRCA1, and the human homolog of yeast budding uninhibited by benzimidazole (BubR1). Methodology and Principal Findings. We performed real-time quantitative polymerase chain reaction (RT-QPCR) in frozen lung cancer tissue specimens from 126 chemonaive NSCLC patients who had undergone surgical resection and evaluated the association between gene expression levels and survival. For validation, we used paraffin-embedded specimens from 58 other NSCLC patients. A strong inter-gene correlation was observed between expression levels of all genes except NFAT. A Cox proportional hazards model indicated that along with disease stage, BRCA1 mRNA expression significantly correlated with overall survival (hazard ratio [HR], 1.98 [95% confidence interval (CI), 1.11-6]; P = 0.02). In the independent cohort of 58 patients, BRCA1 mRNA expression also significantly correlated with survival (HR, 2.4 [95%CI, 1.01-5.92]; P = 0.04). Conclusions. Overexpression of BRCA1 mRNA was strongly associated with poor survival in NSCLC patients, and the validation of this finding in an independent data set further strengthened this association. Since BRCA1 mRNA expression has previously been linked to differential sensitivity to cisplatin and antimicrotubule drugs, BRCA1 mRNA expression may provide additional information for customizing adjuvant antimicrotubule-based chemotherapy, especially in stage IB, where the role of adjuvant chemotherapy has not been clearly demonstrated.
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Concomitant active tuberculosis prolongs survival in non-small cell lung cancer: a study in a tuberculosis-endemic country.

Concomitant active tuberculosis prolongs survival in non-small cell lung cancer: a study in a tuberculosis-endemic country.

A total 276 advanced NSCLC patients were included, with 11 (4.0%) stage IIIA, 98 (35.5%) stage IIIB and 167 (60.5%) stage IV. One hundred fifteen patients received first-line platinum-based doublet, with gemcitabine in 63 (54.8%), docetaxel in 18 (15.7%), paclitaxol in 13 (11.3%), vinorelbine in 16 (13.9%) and pemetrexed in 5 (4.3%). Thirty patients received first-line single agent chemotherapy, with gemcitabine in 16 (53.3%), docetaxel in 8 (26.7%), paclitaxol in 2 (6.7%), vinorelbine in 4 (13.3%). Fifty- nine and seventy-two patients were respectively placed on first-line target therapy and best supportive care alone. In active TB group, nine (17.3%) had suspicious old pulmonary TB lesions based on image studies and four (7.7%) had documented history of previous anti-TB therapy. Eight (15.4%) out of fifty-two showed biopsy- proven caseous granulomatous inflammation on histology. Table 1 shows the baseline characteristics of all patients.
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Einstein (São Paulo)  vol.13 número2

Einstein (São Paulo) vol.13 número2

Objective: To report the demographic data and clinical outcomes of non-small-cell lung cancer patients exposed to erlotinib in any line of treatment. Methods: This was a retrospective cohort study of non- small-cell lung cancer patients from a reference general hospital and a private oncology clinic, who received erlotinib from 2005 to 2011. Statistical analysis was performed and we evaluated demographic data and response to treatment, by correlating the results of this first cohort published in Brazil with results of current literature. Results: A total of 44 patients were included; 65.9% were diagnosed with adenocarcinoma, and 63.6% had metastatic disease. The mean age was 63.3 years. The median follow-up was 47.9 months. Epidermal growth factor receptor mutation screening was performed in 22.7% of patients (n=10), with mutation present in 30% of patients. The median overall survival was 46.3 months, and there was a higher probability of survival at 60 months for females compared to males (29.4% versus 15.8%; p=0.042). The other variables did not present significant statistical difference. Conclusion: We collected the largest cohort of patients with non-small-cell lung cancer who have used erlotinib in Brazil to date, and demonstrated that outcomes of patients treated at our clinic during the study period were consistent with the results of current literature in similar patients.
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Baseline and Trend of Lymphocyte-to-Monocyte Ratio as Prognostic Factors in Epidermal Growth Factor Receptor Mutant Non-Small Cell Lung Cancer Patients Treated with First-Line Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors.

Baseline and Trend of Lymphocyte-to-Monocyte Ratio as Prognostic Factors in Epidermal Growth Factor Receptor Mutant Non-Small Cell Lung Cancer Patients Treated with First-Line Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors.

However, our study had several limitations. First, tumor programmed death-ligand 1 expression, which can provide direct information about the degree of immune paralysis in tumor microenvironment, was not available. Second, we do not have immune contexture, the amount of immune cell infiltration, in tumors, which can more precisely reflect the immune response in tumor microenvironment.[23] Further studies are required to determine whether add-on immunotherapy or anti-angiogenesis agents, in addition to first line EGFR-TKIs, could prolong survival in NSCLC patients, especially in those with low LMR. Finally, because our study was a retrospective study with a small patient population, a prospective trial is needed to validate these results.
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Polymorphisms of homologous recombination genes and clinical outcomes of non-small cell lung cancer patients treated with definitive radiotherapy.

Polymorphisms of homologous recombination genes and clinical outcomes of non-small cell lung cancer patients treated with definitive radiotherapy.

Lung cancer leads all other cancers in both incidence and mortality worldwide. Non-small cell lung cancer (NSCLC) accounts for 89% of all lung cancer, and most patients have advanced stages at diagnosis, requiring radiotherapy alone or in combination with chemotherapy to improve the local control and overall survival. However, despite aggressive treatment in these patients, the prognosis is still unsatisfactory, with a 5-year survival rate of about 10% [1] and a median survival time (MST) of 16–18 months [2]. Meanwhile, radiation treatment-related pulmonary toxicity, such as pneumonitis and pulmonary fibrosis, may influence the prognosis of NSCLC patients, because these complications restrict the dose of radiation used and compromise pulmonary functions. Therefore, there has been a persistent interest in search for readily accessible molecular markers that may help assess therapeutic benefits by predicting clinical outcomes of those NSCLC patients who are treated with definitive radio(chemo)therapy.
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Albumin and Neutrophil Combined Prognostic Grade as a New Prognostic Factor in Non-Small Cell Lung Cancer: Results from a Large Consecutive Cohort.

Albumin and Neutrophil Combined Prognostic Grade as a New Prognostic Factor in Non-Small Cell Lung Cancer: Results from a Large Consecutive Cohort.

Neutrophil, an important component of inflammation, is the first type of immune cell that responds to the site of infection and attack invaders directly. Actually, neutrophil guards its conventional positive character as a defender by killing not only invading pathogens but also malignancies. However, the inflammatory cells and cytokines found in tumors are more likely to contribute to tumor growth, progression, and immunosuppression than they are to mount an effective host antitumor response [25]. In 1986, Shoenfeld and colleagues found that high peripheral blood leukocyte count indicated worse prognosis in patients with non-hematologic neoplasms [26]. Thereafter, an increasing number of studies demonstrated neutrophil was related to poor outcome in multiple tumors [27], also in NSCLC [13]. These early reports were consistent with our findings in this study that high pretreatment neutrophil level was associ- ated with worse survival in NSCLC patients. Although exact mechanism for this remains unclear, the reason may be that neutrophils can be recruited by kinds of chemoattractant medi- ators into tumor microenvironment then become pro-tumor N2 phenotype tumor-infiltrating neutrophil (N2-TIN) which can improve tumor progression [12, 28]. Albumin, which is pro- duced by liver, is usually regarded as an index of malnutrition and cachexia when decreased. Evidence suggested that inflammation could suppress albumin synthesis [29] and the progres- sive decrease of albumin was a consequence of systemic inflammation [30]. As another inflam- matory index, hypoalbuminemia was also reported to be associated with poor survival in NSCLC [19]. We speculated the predict value of low pretreatment albumin might be due to dystrophic, lack of immunity and weak status of body. Moreover, chemotherapeutics may remain high residue and high toxicity in the blood stream because of lacking of albumin to bind to the drugs and this may also contribute to cancer mortality. However, both of pretreat- ment albumin and neutrophil levels have not been commonly used in clinic because of their low predict efficiency. The volatility of albumin also limits its application in clinic. Therefore, we gave a hypothesis here that taking pretreatment albumin and neutrophil together, ANPG
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Role of survival post-progression in phase III trials of systemic chemotherapy in advanced non-small-cell lung cancer: a systematic review.

Role of survival post-progression in phase III trials of systemic chemotherapy in advanced non-small-cell lung cancer: a systematic review.

Next, a multiple regression analysis for SPP was conducted to clarify which clinical factors could affect SPP (Table 3). The year of trial initiation was a significant factor (regression coefficient of 0.2776; p,0.001), indicating that SPP has steadily increased over the years even after adjusting other covariates listed in Table 3. Additionally, a longer SPP time was associated with several clinical Figure 2. Time trends in survival data. A. Trend in survival times in advanced NSCLC patients enrolled into phase III trials. Median survival time (0.3751-month [11.253-day] increase per year; p,0.001; blue), median progression-free survival time (0.0621-month [1.863-day] increase per year; p = 0.006; pink), survival post-progression (0.3138-month [9.414-day] increase per year; p,0.001; green). All analyses were weighted by trial size. Y- axis indicates survival time of each endpoint (months). B. Absolute mean SPP value per year. X-axis and Y-axis indicate year of trial initiation and mean SPP value (months) in each year, respectively.
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Sao Paulo Med. J.  vol.134 número5

Sao Paulo Med. J. vol.134 número5

Selection criteria: We included only RCTs that compared non-platinum single-agent therapy versus non-platinum combination therapy, or non-platinum therapy versus platinum combination therapy in pa- tients over 70 years of age with advanced NSCLC. We allowed inclusion of RCTs speciically designed for the elderly population and those de- signed for elderly subgroup analyses.

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J. bras. pneumol.  vol.42 número5

J. bras. pneumol. vol.42 número5

Objective: Lung cancer is a global public health problem and is associated with high mortality. Lung cancer could be largely avoided by reducing the prevalence of smoking. The objective of this study was to analyze the effects of social, behavioral, and clinical factors on the survival time of patients with non-small cell lung cancer treated at Cancer Hospital I of the José Alencar Gomes da Silva National Cancer Institute, located in the city of Rio de Janeiro, Brazil, between 2000 and 2003. Methods: This was a retrospective hospital cohort study involving 1,194 patients. The 60-month disease-speciic survival probabilities were calculated with the Kaplan-Meier method for three stage groups. The importance of the studied factors was assessed with a hierarchical theoretical model after adjustment by Cox multiple regression. Results: The estimated 60-month speciic- disease lethality rate was 86.0%. The 60-month disease-speciic survival probability ranged from 25.0% (stages I/II) to 2.5% (stage IV). The performance status, the intention to treat, and the initial treatment modality were the major prognostic factors identiied in the study population. Conclusions: In this cohort of patients, the disease-speciic survival probabilities were extremely low. We identiied no factors that could be modiied after the diagnosis in order to improve survival. Primary prevention, such as reducing the prevalence of smoking, is still the best method to reduce the number of people who will suffer the consequences of lung cancer.
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An Overview: Treatment of Lung Cancer on Researcher Point of View

An Overview: Treatment of Lung Cancer on Researcher Point of View

Metastatic lung cancer is the type of lung cancer in which cancer cells from any part or any other organ of the body spreads through towards the lungs. Organ which firstly cancer began is called primary cancer. General symptom of metastatic cancers are (1)Fatigue(2)weakness(3)weight loss(4)Metastatic cancer to the lungs is the spread of cancer from another region of Loss of appetite etc. A burden of substantial symptoms occurs in non- small lung cancer and goes through the end of life. In early disease well care leads to improvement in quality and quantity of life as compared with patients’ receiving less aggressive care at the end of life have longer survival [26].An examination of mice having lung cancer tumors. When treated with inhalational formulation of C-DIM5 and C- DIM8. These treatments results in the less protein expression of mediators of tumors initiation, metastasis and other forms that procedures cancer. A tumor marker (CD31, VEGF) shows the suppression of angiogenesis and metastasis. So C-DIM5 and C-DIM8 are antitumor’s [27].A metastatic adenocarcinoma the lungs multiple lesions have cystic appearance are found [28].
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Inglês Jornal Brasileiro de Pneumologia complete v42n5 EN

Inglês Jornal Brasileiro de Pneumologia complete v42n5 EN

We report the case of a 59-year-old male outpatient who presented with hemoptysis for two weeks. He was an active smoker and had a 25-pack-year smoking history. He had been working in a restaurant in Japan for 5 years and reported having ingested a large number of raw peanuts just before the hemoptysis episodes. He came back to Brazil to have this symptom investigated. Clinical examination revealed a good general condition of the patient, no fever or respiratory distress. Auscultation was clear; chest X-ray revealed haziness in the right upper lobe, whereas CT of the chest showed a large opacity with a ground-glass halo in the posterior segment of the upper right lobe (Figures 1A and 1B). Immunological tests were normal, and HIV serology was negative. Fiberoptic bronchoscopy revealed blood in the right upper lobe bronchus; BAL luid was bloody, and its culture was negative for bacteria and fungi. The patient was started on a seven-day course with amoxicillin/clavulanate; no clinical difference was observed. Two weeks later, the patient presented with dyspnea, wheezing, cough, and increased hemoptysis. Surgical lung biopsy was performed and the histopathological examination of the specimen revealed alveolar hemorrhage. Culture from the biopsy fragments was carried out by using ten tubes containing Sabouraud glucose agar without cycloheximide, which were incubated in the darkness at 25ºC and examined daily. Fourteen days later, there was growth of a pure culture presenting as dark green colonies with black reverse. Microculture assays showed conidiophores branching terminally and laterally, allowing the identiication of the fungus as C. cladosporioides (Figures 1C and 1D). There was no growth of any type of bacteria in the cultures.
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Endobronchial mucosa invasion predicts survival in patients with small cell lung cancer.

Endobronchial mucosa invasion predicts survival in patients with small cell lung cancer.

The probable location of the lesion was determined initially by conventional posterior anterior chest radiography with or without chest CT. A flexible fiberoptic bronchoscope (BF-P240 or BF-40, Olympus, Tokyo, Japan) was then inserted via nostril after local spray of 2% xylocaine for anesthesia. The heart rate and oxygen saturation of each patient was monitored by a pulse oximeter during the procedure. In all patients, visual inspection of the larynx, vocal cords, trachea, carina, and all segmental orifices of both lungs was performed. Normal saline solution was instilled through the bronchoscope, with aspiration of washings for cytologic examination. Bronchial biopsies were done with forceps, and a minimum of three biopsies were taken. Bronchial biopsies were performed on suspicious lesions including endo- bronchial nodules and narrowing or obliteration of the bronchial lumen by swollen mucosa. Mucosal involvement was confirmed by histological examination (Figure 1). The endo- bronchial mucosal invasion was defined as tumor extends above the lamina propria of the mucosae. Each patient received at least 3 pieces of samples (4.5 mean, range 3 to 6) from the involved site. All samples were embedded in paraffin, and cut at the same thickening at fixed distance into 4 slides. Patient will be classified if any of the slides presented with tumor extends above the lamina propria.
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