52

Clinical assessment

The value of mass radiographic screening fur the early detection of carcinoma of the lung Schildge J, Cegla M, Ortlieb H, Schultc-Monting J. Abt. Lungenchirur- gie, Chirug. Universirarsklinik Freiburg, Freiburg. Pneumologie 1989;43:500-6.

On 30.6.1983, mass radiographic screening was abandoned despite objections to the effect that it offered the only chance of detecting carcinomaofthelungatanear1y stage. Inaretrospecdveanalysisofour patient malerial comprising 1.010 patients with bronclual carcinomas seen within thcpericdbetwccn 1 .l.l980m 31.12.1986,weinvcstigated lhe question as to whether these ObJeclions might not bc justified. Four hundred and thirty-seven patients seen prior to 30.6.1983 were com- pared with 537 palients examined after this date, on the basis of the following parameters: age-sex-symptomatology-cancer stage-histol- ogy-treatment. After stopping mass radiographic screening, an increase in age and symptomatic tumour findings was observed, and thus a shift towards more advanced stages of carcmoma. A relative decrease in the number of squamous cell carcinomas, and a relative increase in the number of adenocarcinomas were observed. All the parameters in the patients identified at mass radiographic screening were comparable wilh those seen in patients identified incidentally. In comparison with symptomatic patients, those identified by mass radiography screening more frequently presented with earlier turnour stages, and the lesions were more frequently rcsectablc. All in all, over a period of three and one-half years, mass radiographic screening revealed 23.8% of all cancers of the lung, and 36.8% of all rcscctable lesions. After the abandonment of mass radiographic screening, an mcrcasc in more advanced and symptomatic turnours was obscrvcd.

Evalution of the extent of lung cancer Milleron B, Mayaud C, Akoun G. Cenrre de Pneurnologie el de ReanimaGon Respiraroire. Ilopiuzl Tenon, F-75970 Paris Cedex 20. Presse Med 1989;18:1387-9.

The variety of individual opnnons cncountercd in the evaluation of lung cancer is due to the multiplicity of investigations. The inuathoracic extent is basically assessed by bronchial fibroscopy wnh tlcrcd biopsies and computerized tomography. The specificity of computeriLed Iomo- graphy in the evaluation of lymph node involvcmcnt ncvcr exceeds 75 per cent, and although this figure is higher as regards mediastinal or direct chest wall involvement, it ncvcr reaches 100 per cent. The information provided by magnetic resonance imaging is not better. Metastatic extension is evaluated by abdominal uluasonography and computerized tomography of Ihe brain and of Ihe upper abdomen. Sys- tematic radionuclide bone scanning is debatable and some other exami- nations must be reserved to certam histological types; this is the case with bone marrow biopsy (comphxed, if ncccssary, by monoclonal antibodies) or magnetic rcsonancc imaging of bones in small cell carcinomas. The levels of some markers arc well corrclatcd wnh tumoral dissemination.

Cholecystokinin elevates cytosolic calcium in small cell lung cancer cells Slaley J, Fiskum G, Moody TW. Department of Biochemistry and Molecular Biology, George Washingron Unrversily SchoolofMedicine and Health Sciences, Washington, DC 20037. Biochem Biophys Res Commun 1989;163:605-10.

The ability of cholecystokinin (CCK) to elevate intracellular Ca” levels in small cell lung cancer cells was mvestigated using the fluorescent Ca2+ indicator Fura 2. CCK-8 clcvated Ihe cytosolic Ca*+ levels in cell hne NCI-H345 in a dose dcpcndcnt manner. Nanomolar concenuation of CCK-8 elevated cytosolic Ca” levels m the absence or presence of cxuacellular Ca2’. Potent CCK agonists such as gasuin-I and nonsulfated CCK-8 but not inacnve compounds such as CCK-27-

32-NH, elevated cytosolic Ca 2+ levels. Thcsc dala suggest that CCK receptors may regulate the release of Ca2+ from intracellular organelles in small cell lung cancer cells.

Lack of relationship between in vitro tumor cell growth and prog- nosis in extensive-stage small-cell lung cancer Stevenson HC. Gazdar AF, Linnoila RI ct al. National Cancer Insritule- Navy Medical Oncology Branch, Naval Hospital, Bethesda. MD 20814. J Clin 0x01 1989;7:923-31.

The ability to establish a conlinuously growing tumor ceil line from fresh tumor specimens has been associated with shortened survival in some human malignancies. Therefore. we assessed the relationship between survival and in vitro tumor cell growth from specimens obtained during routine staging procedures in 68 consecutive patients with untreated, extensive-stage small-cell lung cancer (SCLC) who received etoposide/cisplatin chemotherapy. Three groups of SCLC patientscouldbedistinguishcd: (1)23patientsm whomatumorcellline was established in vitro; (2) 28 patients in whom tumor-containing specimens were cultured but in vitro growth did not occur; and (3) 17 patients in whom no tumor-containing specimen could be procured. No significant difference in response rates to chemotherapy of the three groups was noted. Poor performance status (P, = X01), male gender (P2 =.0008),liverme~stases(P,=.0033),brainmetastases(P,=.0152),and the ability to obtain a tumor-conmining specimen from the patient for laboratory culture (P2 = X05) were all significant independent predic- tors of decreased survival in this patient population. While the ability to obtain a tumor cell specimen for cell culture using routine staging and diagnostic procedures identified patients with shortened survival, we found no significant survival differences between patients whose tumor cell specimens grew in cell culture v those that did not (median survival of 7 months v 11 months, P, = .72). Our study indicates that the clinical outcome ofextensive-stage SCLC patients from whom tumor cell lines can beestablished is not significantly dlffercnt than in thosecases from whom tumor-containing specimens could not be grown in vitro.

Serum CK-BB as a tumor marker in patients with carcinoma confirmed histologically Arenas J, Diaz AE, Alcaide MJ, Santos I, Martinez A, Culebras JM. Servicio de Bioquimica. Hopital ’ 12 de Octubre’, 28041 Ma&id. Clin Chim Acta 1989;182:183-94.

We determined serum CK-BB mass concentration using a specific RIA method, in 267 patients wilh carcmoma confirmed histologically distributed as follows: 46 pros&tic adenocarcinoma, 52 lung neoplasies, 70 colon carcinoma, 52 breast carcinoma and4 I gastric carcinoma; and also in 135 patients with histologically proved non-neoplastic diseases distributed as follows: 28 prostatic hyperplasy, 31 lung tuberculosis, 29 inflammatory bowel disease, 27 fibrocystic mastopathy and 20 gastro- duodenal ulcer. Reference values in healthy subjects (n = 360) were 5.46 f 2.68 (SD) &ml. We found that serum CK-BB mass concentration is not a specific tumor marker but it is a valuable indicator of responsing to therapy and metastatic widespread. Howcvcr, in prostatic carcinoma

prevalence 0.25, prcdictivc positive value (PPV) 0.51 and predictive negative value (PNV) 0.88 and breast carcinoma prevalence 0.32, PPV 0.6Oand PNV 0.87 strum CK-BB can bc used as a tumor marker. Only 12 over 268 patients with different neoplasnc disease (4.47%) showed detectable serum CK-BB catalytic concentrations.

Thrumhosis-inducing activity found in plasma from two patients with advanced lung cancer MaruyamaM, Yagawa K, Kinjo M etal. ResearchlnsritureforDiseases of rhe Chesr, Faculty of Medicine. Kyushu University, Fukuoka 812. Oncology 1989;46:25 1-4.

In 2 patients with lung cancer, the coagulation system was supposed to be activated by the findings of elevation of plasma fibrinogen, fibrinogen degradation product (FDP) and/or peripheral platelet counts. The plasma thromboxane B, and 6.kern-prostaglandin F( 13 levels in 1