Clinicopathological and Prognostic Features of 67 Cases with Pulmonary Sarcomatoid Carcinoma: An 18-Year Single-Centre Experience

2021 ◽  
pp. 1-10
Author(s):  
Ferhat Ferhatoglu ◽  
Fahmin Amirov ◽  
Berker Ozkan ◽  
Murat Kara ◽  
Alper Toker ◽  
...  
Keyword(s):  
Prognostic Significance ◽  
Sarcomatoid Carcinoma ◽  
Stage Iv ◽  
Pleomorphic Carcinoma ◽  
Smoking History ◽  
Advanced Stage ◽  
Epithelial Markers ◽  
Prognostic Features ◽  
Stage Iv Disease ◽  
Pulmonary Sarcomatoid Carcinoma

<b><i>Introduction:</i></b> Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small-cell lung cancer (NSCLC). It is frequently diagnosed in the advanced stage and is resistant to conventional chemotherapeutics. Due to the unique nature and rarity, we evaluated the epidemiological, clinicopathological, and survival data of PSC patients treated at our centre. <b><i>Patients and Methods:</i></b> We retrospectively collected demographic and clinical data of 67 PSC patients from a single tertiary referral hospital, between the 2000 and 2018. Univariate and multivariate analyses were performed to determine the risk factors affecting survival. <b><i>Results:</i></b> The median age was 61 years, and the percentage of male was 74.6%. Most of the patients had a smoking history (76.9%). The most common PSC subtype was pleomorphic carcinoma (46.3%). The median overall survival (OS) was 55.4 months, and the 5-year OS rate was 47.5%. Advanced stage, T4 tumour, and positive lymph node involvement were associated with poor OS (<i>p</i> &#x3c; 0.05). The patients with negative epithelial markers had poorer prognosis (<i>p</i> = 0.027) and had more frequently stage IV disease (<i>p</i> = 0.016). Surgical treatment and stage IV disease were determined to be independent prognostic factors. <b><i>Conclusion:</i></b> PSC is an extremely rare and aggressive variant of NSCLC. Positive epithelial markers may have favourable prognostic significance in PSC. Resection of the tumour with a negative surgical margin is crucial for better survival. The prognosis of the disease is very poor in the metastatic stage.

Limited Benefit Gained From Inferior Vena Cava Filter Insertion In Patients With Advanced-Stage Cancer

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1147-1147
Author(s):  
Asem Mansour ◽  
Yousef Ismael ◽  
Hikmat Abdel-Razeq
Keyword(s):  
Cancer Patients ◽  
Survival Data ◽  
Vena Cava ◽  
Stage Iv ◽  
Stage Iii ◽  
Advanced Stage ◽  
Ivc Filter ◽  
Filter Placement ◽  
Stage Iv Disease ◽  
Filter Insertion

Abstract Introduction Cancer and its treatment are recognized risk factors for venous thromboembolism (VTE). Inferior Vena Cava (IVC) filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism (PE) or to avoid bleeding from systemic anticoagulation in high risk patients. Patients and Methods This study was performed at a stand-alone, Joint Commission International (JCI)-accredited comprehensive cancer center. Hospital database was searched for all patients discharged with IVC filter insertion. Additionally, the radiology database was queried for cancer patients undergoing IVC filter placement. Results A total of 107 cancer patients; 59 (55.1%) males and 48 (44.9%) females who had their IVC filter inserted and followed up at our institution were included. The mean age (±SD) of the whole group was 50.8 (± 14.2) years. All patients had active cancer; the most common primary sites were gastrointestinal 32 (29.9%), brain 16 (15.0%) lung 13 (12.1%) and gynecological tumors 11 (10.3%). Majority of the patients had advanced-stage disease; out of 86 patients with identifiable TNM stage (Tumor, Node, Metastasis), 81 (94.2%) patients had locally-advanced stage III or metastatic stage IV disease, whereas only 5 (5.8%) had stages I or II disease. During the 6 weeks prior to IVC filter placement, 74 (69.2%) patients were on active anticancer therapy with 45 (42.1%) were on chemotherapy and 7 (6.5%) were on radiotherapy. Nineteen (17.8%) of the patients had surgical intervention for their cancer while only 3 (2.8%) were on hormonal therapy. The remaining 33 (30.8%) patients were on hospice and palliative care service with 18 (16.8%) were already placed “DNR” (Don't Resuscitate). Prior to IVC filter insertion, a diagnosis of DVT was made on 76 (71.0%) patients while 14 (13.1%) had PE; the other 17 (15.9%) had both DVT and PE. Contraindication to anticoagulation was the main indication for IVC filter placement reported in 85 (79.4%), while 18 (16.8%) had their filter inserted because of failure of anticoagulation (had DVT and/or PE while on therapeutic doses of anticoagulation). Other indications included large, free-floating iliocaval thrombus and poor compliance with anticoagulation. Filters were placed utilizing the jugular approach in 86 (80.3%) while 18 (16.8%) had their filter placed through a femoral approach. Complications following IVC filter placement occurred in 14 (13.1%); majority were recurrent DVT in 10 (9.3%), PE in 3 (2.8%) and filter thrombosis in one patient. Following IVC filter insertion, 42 (39.3%) were also anticoagulated; majority (86%) with LMWH (enoxaparin or tinzaparin). Twenty (47.6%) of these anticoagulated patients were considered, at the time of IVC filter insertion, as having a contraindication to anticoagulation. Survival data following IVC filter insertion was available for 100 patients. The median survival for the whole group was 2.39 months (range: 0.03-60.2). The median survival for patients with stage III and IV disease were 7.97 (1.90-17.08) and 1.31 months (0.92-2.20), respectively; p=0.0119; (Figure) Few patients had stage I and II disease (two had stage I while three others had stage II disease) and thus were excluded from survival analysis. Among the 59 patients with stage IV disease for whom survival data was available, 23 (39.0%) survived less than a month, while 40 (67.8%) survived less than three months. Survivals of patients with stage III disease were better with only one out of 20 patients (5.0%) survived less than a month, while 14 (70.0%) survived more than three months. Conclusions Cancer patients with advanced-stage disease may gain little benefit from IVC filter insertion, so disease stage and life expectancy should be taken in consideration prior to filter placement. Disclosures: No relevant conflicts of interest to declare.

Responses to immune checkpoint therapy in pulmonary sarcomatoid carcinoma: A retrospective review.

2019 ◽  
Vol 37 (8_suppl) ◽  
pp. 115-115 ◽  
Author(s):  
Vineeth Sukrithan ◽  
Jason Sandler ◽  
Rasim A. Gucalp ◽  
Richard J. Gralla ◽  
Balazs Halmos
Keyword(s):  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Sarcomatoid Carcinoma ◽  
Stage Iv ◽  
Poor Response ◽  
Complete Response ◽  
Routine Care ◽  
Infectious Complications ◽  
Response To Chemotherapy ◽  
Pulmonary Sarcomatoid Carcinoma

115 Background: Advanced Pulmonary Sarcomatoid Carcinoma (PSC) is associated with poor response to chemotherapy and a median survival of 4-6 months. PSC have a high frequency of PD-L1 positivity and high tumor mutational burden, which are markers of benefit with immune checkpoint inhibitors (ICPI). The parameters of response and survival for PSC treated in the era of immune checkpoint inhibition are unknown. Methods: A review of all cases of advanced PSC diagnosed at two institutions in Bronx, NY between 6/2015-6/2018 was performed. Responses were assessed by serial imaging obtained during routine care and graded by RECIST criteria v 1.1. Results: Five cases of advanced Stage IV PSC are reported. The median age was 57 years and all had received ICPI. All cases were smokers with a median of 30 pack-years and TPS > 75%. Three patients received Pembrolizumab as front-line therapy. Responses were seen in four out of five patients, including one complete response. The fifth patient had prolonged disease stability. After a median follow-up of 13 months, none of the patients had progressed. One patient died of infectious complications after 23 months with no evidence of progression. Four patients continue to be alive with ongoing OS ranging between 14-33 months. Conclusions: ICPI therapy has robust activity in advanced PSC and offers an effective line of therapy in this treatment-refractory aggressive malignancy. [Table: see text]

scholarly journals Simplified Molecular Classification of Lung Adenocarcinomas Based on EGFR, KRAS, and TP53 Mutations

2019 ◽  
Author(s):  
Roberto Ruiz-Cordero ◽  
Junsheng Ma ◽  
Abha Khanna ◽  
Genevieve Ray Lyons ◽  
Waree Rinsurongkawong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lung Adenocarcinoma ◽  
Survival Data ◽  
Molecular Subtypes ◽  
Stage Iv ◽  
Molecular Classification ◽  
Smoking History ◽  
Egfr Mutations ◽  
Prognostic Features ◽  
Mutational Status

Abstract Introduction: Gene expression profiling has consistently identified three molecular subtypes of lung adenocarcinoma that have prognostic implications. To facilitate stratification of patients with this disease into similar molecular subtypes, we developed and validated a simple, mutually exclusive classification. Methods: Mutational status of EGFR, KRAS, and TP53 was used to define six mutually exclusive molecular subtypes. A development cohort of 283 cytology specimens of lung adenocarcinoma was used to evaluate the associations between the proposed classification and clinicopathologic variables including demographic characteristics, smoking history, fluorescence in situ hybridization and molecular results. For validation and prognostic assessment, 63 of the 283 cytology specimens with available survival data were combined with a separate cohort of 428 surgical pathology specimens of lung adenocarcinoma. Results: The proposed classification yielded significant associations between these molecular subtypes and clinical and prognostic features. We found better overall survival in patients who underwent surgery and had tumors enriched for EGFR mutations. Worse overall survival was associated with older age, stage IV disease, and tumors with co- mutations in KRAS and TP53. Interestingly, neither chemotherapy nor radiation therapy showed benefit to overall survival. Conclusions: The mutational status of EGFR, KRAS, and TP53 can be used to easily classify lung adenocarcinoma patients into six subtypes that show a relationship with prognosis, especially in patients who underwent surgery, and these subtypes are similar to classifications based on more complex genomic methods reported previously.

scholarly journals Simplified Molecular Classification of Lung Adenocarcinomas Based on EGFR, KRAS, and TP53 Mutations

2019 ◽  
Author(s):  
Roberto Ruiz-Cordero ◽  
Junsheng Ma ◽  
Abha Khanna ◽  
Genevieve Ray Lyons ◽  
Waree Rinsurongkawong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lung Adenocarcinoma ◽  
Survival Data ◽  
Molecular Subtypes ◽  
Stage Iv ◽  
Molecular Classification ◽  
Smoking History ◽  
Egfr Mutations ◽  
Prognostic Features ◽  
Mutational Status

Abstract Background: Gene expression profiling has consistently identified three molecular subtypes of lung adenocarcinoma that have prognostic implications. To facilitate stratification of patients with this disease into similar molecular subtypes, we developed and validated a simple, mutually exclusive classification. Methods: Mutational status of EGFR, KRAS, and TP53 was used to define seven mutually exclusive molecular subtypes. A development cohort of 283 cytology specimens of lung adenocarcinoma was used to evaluate the associations between the proposed classification and clinicopathologic variables including demographic characteristics, smoking history, fluorescence in situ hybridization and molecular results. For validation and prognostic assessment, 63 of the 283 cytology specimens with available survival data were combined with a separate cohort of 428 surgical pathology specimens of lung adenocarcinoma. Results: The proposed classification yielded significant associations between these molecular subtypes and clinical and prognostic features. We found better overall survival in patients who underwent surgery and had tumors enriched for EGFR mutations. Worse overall survival was associated with older age, stage IV disease, and tumors with co-mutations in KRAS and TP53. Interestingly, neither chemotherapy nor radiation therapy showed benefit to overall survival. Conclusions: The mutational status of EGFR, KRAS, and TP53 can be used to easily classify lung adenocarcinoma patients into seven subtypes that show a relationship with prognosis, especially in patients who underwent surgery, and these subtypes are similar to classifications based on more complex genomic methods reported previously.

Improved outcomes in advanced stage uterine carcinosarcoma (mixed mullerian tumor [MMT])

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5518-5518
Author(s):  
D. M. O'Malley ◽  
C. Nagel ◽  
L. A. Cantrell ◽  
L. Havrilesky ◽  
M. Liotta ◽  
...  
Keyword(s):  
Late Stage ◽  
Therapy Group ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Postoperative Treatment ◽  
Treatment Modalities ◽  
Advanced Stage ◽  
Treatment Regimens ◽  
Time To Recurrence ◽  
Stage Iv Disease

5518 Background: There is currently no consensus regarding the management of advanced stage uterine MMT. In an effort to better define postoperative treatment modalities and their associated outcomes, we retrospectively reviewed factors that influence progression and survival. Methods: A retrospective, multi-institution study of women diagnosed from 1997–2007 was performed. Post-operative treatment included either observation (OBS), RT (brachytherapy, whole pelvic, or combination), chemotherapy (CT) alone or with RT (CT+RT). The majority of chemotherapy regimens included carboplatinum/paclitaxel, Ifosfamide/cisplatin, cisplatin/adriamycin, Data collected included time to recurrence, overall survival and sites of recurrence. Statistics included t-test, ANOVA and Kaplan Meier. Results: 119 patients were identified with late stage uterine MMT. 81 had stage III disease and 38 had stage IV disease. The median age at diagnosis was 67 years (range: 30–86). 70 (59%) were Caucasian and 48 (40%) were African-American. 116 (87%) were optimally debulked and their survival further analyzed. 18 (15%) were observed and 9 of these patients recurred. This group had the poorest median progression free survival (PFS) of 3.4 months. The majority (N = 50, 49%) of late stage patients underwent adjuvant CT with a median PFS of 13.3 months and median OS of 15.6 months. Of these patients 33 (66%) recurred. 18 (17 %) patients underwent RT alone with a median PFS of 12.4 months and OS of 14.9 months. 14 (78%) of these patients recurred. 20 patients (19%) underwent a combination of CT and RT and 11 (55%) experienced recurrences . The combination therapy group had the longest median PFS of 14.3 months and OS of 17.2 months (p = 0.27). Conclusions: Chemotherapy had become the standard therapy for advanced stage MMT however the addition of radiation has not been established. Patients diagnosed with advanced stage MMT can achieve long-term DFS in a minority of patients (33%) treated with chemotherapy. We showed that the addition of radiation to adjuvant chemotherapy showed a slight improvement over chemotherapy alone yet the optimal therapy has yet to be defined. This retrospective review highlights the need for prospective trials of new therapeutic agents and treatment regimens for women with advanced stage uterine MMT. No significant financial relationships to disclose.

scholarly journals Simplified Molecular Classification of Lung Adenocarcinomas Based on EGFR, KRAS, and TP53 Mutations

2020 ◽  
Author(s):  
Roberto Ruiz-Cordero ◽  
Junsheng Ma ◽  
Abha Khanna ◽  
Genevieve Ray Lyons ◽  
Waree Rinsurongkawong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lung Adenocarcinoma ◽  
Survival Data ◽  
Molecular Subtypes ◽  
Stage Iv ◽  
Molecular Classification ◽  
Smoking History ◽  
Egfr Mutations ◽  
Prognostic Features ◽  
Mutational Status

Abstract Background: Gene expression profiling has consistently identified three molecular subtypes of lung adenocarcinoma that have prognostic implications. To facilitate stratification of patients with this disease into similar molecular subtypes, we developed and validated a simple, mutually exclusive classification. Methods: Mutational status of EGFR , KRAS , and TP53 was used to define seven mutually exclusive molecular subtypes. A development cohort of 283 cytology specimens of lung adenocarcinoma was used to evaluate the associations between the proposed classification and clinicopathologic variables including demographic characteristics, smoking history, fluorescence in situ hybridization and molecular results. For validation and prognostic assessment, 63 of the 283 cytology specimens with available survival data were combined with a separate cohort of 428 surgical pathology specimens of lung adenocarcinoma. Results: The proposed classification yielded significant associations between these molecular subtypes and clinical and prognostic features. We found better overall survival in patients who underwent surgery and had tumors enriched for EGFR mutations. Worse overall survival was associated with older age, stage IV disease, and tumors with co-mutations in KRAS and TP53 . Interestingly, neither chemotherapy nor radiation therapy showed benefit to overall survival. Conclusions: The mutational status of EGFR , KRAS , and TP53 can be used to easily classify lung adenocarcinoma patients into seven subtypes that show a relationship with prognosis, especially in patients who underwent surgery, and these subtypes are similar to classifications based on more complex genomic methods reported previously.

Effect of BRM promoter variants on survival outcomes of stage III-IV non-small cell lung cancer (NSCLC) patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 11057-11057 ◽  
Author(s):  
Sinead Cuffe ◽  
Lu Cheng ◽  
Abul Kalam Azad ◽  
Yonathan Brhane ◽  
Dangxiao Cheng ◽  
...  
Keyword(s):  
Histone Deacetylases ◽  
Susceptibility Gene ◽  
Prognostic Significance ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Stage Iii ◽  
Survival Outcomes ◽  
Increased Risk ◽  
Stage Iv Disease ◽  
Nsclc Patients

11057 Background: BRM, a key catalytic subunit of the SWI/SNF chromatin remodeling complex, is a putative tumor susceptibility gene in NSCLC. Loss of BRM expression occurs in 15% of NSCLC, and has been linked to adverse outcome. Recently, our group has shown that variants of two novel BRM promoter insertion polymorphisms (BRM-741, BRM-1321) lead to loss of BRM expression by recruiting histone deacetylases; individuals carrying homozygous variants for both polymorphisms have doubled NSCLC risk; pharmacological reversal of these epigenetic changes is a potentially viable therapeutic strategy. We thus evaluated the effect of BRM promoter variants on survival outcomes of advanced NSCLC patients, where initial clinical trials are likely to be focused. Methods: 564 stage III-IV NSCLC patients were genotyped for the BRM promoter variants using Taqman. Association of BRM variants and overall (OS) and progression-free survival (PFS) were assessed using Cox proportional hazard models adjusted for prognostic variables. Results: Among our patients, 73% were Caucasian, 52% male, median age 63yrs, 55% stage IV disease, and 67% adenocarcinoma. Median OS was 1.6yrs; median follow up, 3.6yrs. The frequency of homozygosity was BRM-741, 23%; BRM-1321, 21%; both, 12%. Homozygous variants of BRM-741 were strongly associated with worse OS (adjusted HR [aHR] 2.3 [p=2x10E-8]) and PFS (aHR 2.0 [p=2x10E-7]) compared to the wild types. Similar findings were observed for BRM-1321 homozygous variants (aHR for OS 1.8 [p=8x10E-5] and aHR for PFS 1.6 [p=2x10E-4]). Carrying homozygous variants of both BRM-741 and BRM-1321 was associated with substantially worse OS (aHR 2.3 [p=1x10E-5]) and PFS (aHR 2.2 [p=3x10E-6]), with similar associations seen among the stage III (aHR for OS 2.3 [p=6x10E-6]) and stage IV (aHR for OS 2.5 [p=5x10E-6]) patients. Conclusions: The same two homozygous BRM promoter variants that are associated with increased risk of NSCLC are also strongly associated with adverse OS and PFS in this cohort of stage III-IV NSCLC patients. Validation of results in a clinical trial dataset is underway, and will better elucidate the prognostic significance of these BRM promoter variants.

The pattern of mucin 5AC (MUC5AC) expression using immunohistochemistry and its prognostic significance in patients with pancreatic ductal adenocarcinoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16756-e16756
Author(s):  
Ashish Manne ◽  
Wadad Mneimneh ◽  
Osama Elkadi ◽  
Daisy E Escobar ◽  
James Coley ◽  
...  
Keyword(s):  
Overall Survival ◽  
Retrospective Study ◽  
Statistical Analysis ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Prognostic Significance ◽  
Stage Iv ◽  
Ductal Adenocarcinoma ◽  
Ampullary Adenocarcinoma ◽  
Stage Iv Disease ◽  
The University

e16756 Background: Mucin-5AC (MUC5AC) is a secreted form of mucin. Its expression correlates with poor outcome in uterine, ampullary adenocarcinoma and cholangiocarcinoma. Its prognostic significance in pancreatic ductal adenocarcinoma (PDAC) is not well established. Here, we explored the pattern of MUC5AC expression using immunohistochemistry (IHC) and its prognostic significance in patients with PDAC. Methods: This is a retrospective study conducted at the University of South Alabama/Mitchell Cancer Institute. Between 2015-2019, 218 patients with PDAC were identified. Among this cohort, only 45 patients had tissue available for MUC5AC IHC staining. Two pathologists in- dependently scored the expression of MUC5AC. Staining percentage was estimated in 10% increments. Unpaired t test and log-rank Wilcoxon tests were used for statistical analysis. Results: In our cohort, the median age was 65 years (42-85). Males represented 55%. Caucasians, African Americans and other ethnicities (e.g. Asians) represented 71%, 25% and 4% respectively. Twenty patients (44%) had metastatic stage IV disease and 25 patients (56%) had non-metastatic disease. Positive cytoplasmic and apical MUC5AC expression by IHC was seen in 82% and 80% of patients respectively. The median apical MUC5AC expression was higher in metastatic patients compared to non-metastatic patients (67.5 % vs 30%, p = 0.0187 ) while there was no difference in the median cytoplasmic MUC5AC expression between metastatic and non-metastatic patients (13.7 % vs 12.5%, p = 0.3328). In non-metastatic patients, compared to patients with positive apical MUC5AC expression, no expression (0%) was associated with worse overall survival (OS) (43 vs 13 m, p = 0.0322). In metastatic PDAC, there was no difference in OS between patients with positive or no apical MUC5AC expression (18 vs 21 m, p = 0.781). Compared to patients with positive cytoplasmic MUC5AC expression, patients with no cytoplasmic MUC5AC expression (0%) had no difference in OS in both non-metastatic (40 vs 32 m, p = 0.986) and metastatic (36 vs 12.5 m, p = 0.487) patients. Conclusions: MUC5AC expression assessment using IHC is feasible in patients with PDAC. In our cohort, apical, but not cytoplasmic, MUC5AC expression was different between metastatic and non-metatstaic patients and showed prognostic significance in non-metastatic patients. To our knowledge, this is the first study to show prognostic significance of MUC5AC expression in patients with PDAC using IHC.

Prognostic significance of clinical features and Akt activation in the survival of patients with bronchioloalveolar carcinoma (BAC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7217-7217
Author(s):  
M. S. Ballas ◽  
J. Tsurutani ◽  
S. Steinberg ◽  
M. Robertson ◽  
V. Egilsson ◽  
...  
Keyword(s):  
Clinical Features ◽  
Cox Model ◽  
Smoking Status ◽  
Prognostic Significance ◽  
Egfr Inhibitors ◽  
Smoking History ◽  
Poor Prognostic Factor ◽  
Akt Activation ◽  
Prognostic Features ◽  
Worse Prognosis

7217 Background: Lung cancer is the leading cause of cancer related mortality in the world. BAC is a subset of NSCLC that has recently gained attention because of enhanced efficacy of epidermal growth factor receptor (EGFR) inhibitors in this population. Prognostic features for BAC have not been well defined. Because activation of Akt is a poor prognostic factor for other types of NSCLC, and because changes in Akt may predict outcome for EGFR inhibitors, we assessed the prognostic significance of clinical features and Akt activation in patients with BAC. Methods: 46 cases of BAC were classified according to WHO 2001 criteria. Akt activation was assessed using immunohistochemistry. Associations between ordered Akt levels and other dichotomous parameters were evaluated using an exact Cochran-Armitage test for trend. Survival was analyzed by the Kaplan-Meier method, and hazard ratios (HR) were determined based on Cox proportional hazard models. Results: Tissues from 45 patients were analyzed. Age and histology (mucinous vs. non-mucinous) were not associated with survival. Akt activation was observed in 63% of cases, but was not associated with differences in survival. Complete clinical data (except smoking) were available for 43 patients, and smoking history was available for 31 patients (8 never-smokers, 23 smokers). Cox model analysis revealed that male gender (HR 2.24, 95% CI 1.07–4.71, p = 0.032) and advanced stage (III or IV) (HR 2.17, 95% CI 1.004–4.71, p = 0.049) were associated with a worse prognosis. A model limited only to the 31 patients with smoking data demonstrated that smoking alone (HR 6.89, 95% CI 1.49–31.88, p = 0.013) was associated with a worse prognosis. Conclusions: These studies identify gender, stage, and especially smoking status as potentially important prognostic features for BAC. Akt was not prognostic. Given that the recent NSCLC clinical trials with erlotinib and gefitinib that showed varying survival benefit did not stratify by smoking status and BAC, it is possible that these characteristics could have affected the clinical outcomes. Investigators studying EGFR inhibitors should consider stratifying by smoking status and BAC to determine if there are subsets of patients who could benefit most from these therapies. No significant financial relationships to disclose.

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