134 Abstracts/Lung Cancer 10 (1993) 123-150

andysal for influmce cm tbe type snd dumtioa of response. The complete remission probability was only mlated to pretratme”t extent of disease. I” a multivariate uulysis (Cox) of rsspoose duration, only NSE aI type of response had sigoiticat influwe.. Ccwequently. “wasuemezlt8 of NSE before therapy will be w&l in fvture clinical trials 0” SCLC especially ba sihtations, where Mpondig patients are. submitted to specific treatmnt strategies.

Pain in nmbulalory patients with lung or c&m cancer: FVevalmce, characteristics, and effect Portenoy RK, Mirsnsky I, Thaler HT, Homung J, Bianchi C, Cibas- Kong I et al. Deparmwtt of Neurology. Memorial Sloan-Kettering Cancer Cm.. 1275 York Avenue, New York, h’Y 10021. Cancer 1992;70:1616- 24.

Background: Few shldies have evaluated the epidemiology and effect of pain ia ambulatory patients with cater who am undergoing active therapy. This information is needed t” develop stmtegies for supportive care in this population. Methods: ne prevaleaw snd characteristics of pain were determined in D prospective survey of ambulatory patitients witb lung or colon cancer. To reduce bias Md squire comprehensive information, the methodology used f--to-face interviews by tra&d quality assurzmce analysts, P multifaceted assessment instrument, and multivariate statistical analysis. Results: h P telephone interview, ‘persistent or frequent’ pai” during the previous 2 weeks was repwted by 57 of 145 (39.3%) patients with lung caocera”d 52 of 181(28.7%) patients with co100 cancer; 91 of the-se patients (47 lung and 44 colon) were interviewed in detail. All patients had excellent performance status, andwith theexceptionofpainlocation, therewerenosigniticant differences behveen the hvo tumor types. One-third of the patients had more than ooe discrete pain. Median pain duration was 4 weeks (range, less them 1 week-468 weeks). and average pain intensity was moderate. Approximately 90% of patients experienced pain more thpn 25 % of the time. Pain interfered moderately or more with geoeml activity and work 1” appmximptely half of the patients; more than half reported moderate or greater pain interference in sleep, mood, and enjoyment of life. Multiple regression analysis revealed that the daily frequency of pain, the intensity of the worst pain, the score on a mood scale, and the frequency of the worst pain accounted for 58.7% of the variance in average pain intensity. Likewise. 52.1% of the variance in a derived measure of pi” interference in function was explained by tbe mood score, frequency of the worst pin, number of paiar, and pain intensity. Conclusions: These data indicate that pain is prevalent among well- functioningambulstorypatientsandsubs(antiallycompmmisesfu”ction in appmxinutely half of the patients who experience it. Pain is a complex symptom; aspects other than intensity, such as frequency, strongly influence its effect.

~rog”ostic significance of tumor proliferative fraction and DNA content in stage I non-stud1 cell lung cancer FildcrmPa AE, Silvestri GA, Gatsc& C, Luthriager DJ. Honig J, Fly”” SD. Pdmonmy/Critical Care Med. Dept., St. Joseph Hospital. 2900 N. Lake Shore Driw, Chicago, IL 6061i7. Am Rev Respir Dis 1992;146:707-10.

Analyses of hunor DNA content sod proliferative fraction by flow cytometry have been useful as prog”ostic determinnnts in a variety of solid tumors. The significance of this analysis in StPge I (T,NaM, and T,N&) “~“-sdl ccl1 lung carccinoma (NSCC) is unestablished. We de&m&d DNA contea (ploidy) snd proliferative fraction (percentage s phase) on 44 surgically resected Stage I NSCC specimens obtained bewee.” 1977 a”d 1982. AlIaseshad nminimumfollowvpof5 yr. Of the 44 cases, 27 were ade”oca&io”ms, I5 sgupmouS cell carci”omas, md 2 large cell carcinomps. Of these. 32 (73 %) had T,N,M, lesions and 12 (27%) had TzNoMo lesions. Overall 5-yr survival was 70%. All patients surviving 5 yr were free of detectable tumor. Patients with T,N,M,lesionsbadnn 81% 5-yrsurvivnl. but thosewitbT,N,M,lesions had a 42% 5-yr survival (p = 0.009). Analysis of tllmor DNA content revealed 35 diploid tumors (79%) Md 9 Pneuploid tumors (21%). The 5-yr survival for diploid tumors was 77 96 co-red with D 44 R 5-yr

survival in Pneuploid lesions @ = 0.048). The “wlia” pmlifemtive tiactio” was 6%. All patients with P percentage S phase less thpo 6 A survived 5 yr, Md 41% (9 of 22) of those greater tha” 6 16 survived 5 yr@C0.001).Wbea.8%Spbrrewpsusedpsacutoff,93%(28of30) below the cutoff survived 5 yr but mdy 21% (3 of 14) above the cutoff survived 5 yr @ C 0.001). Withi” the T,N& subgroup (n = 32). all patients with a percentage S phase leas tha” 6 % survived past 5 yr but c&54% (7of 13)ofthosenreptertha6% survived5 vr(” = 0.002). Th& ~~~t”fNmo~~lifentiveFrPetion~d, tbaiesserex& DNA conteat, in Stage I NSCC nuy provide signiticat pmgnostic infonnatio” apart tiom TNM stage md help identify a subset of p&&s at high risk for hlmor relapse.

Ul-d*ded core biopsy of thmxcic tumors Yang P-C, Cba”g D-B, Yu C-J, Lee Y-C. Wu H-D, Ku” S-H et al. Depc#mentqflntemalMedicine, National Taiwan UniwsityHospital, No. I, Chmg-Te Street, Taipei 100. Am Rev Respir Dis 1992146: 763-7.

Two hundred and eightea patients. with thowic tumors larger than 3 cm in size, underwat ultmsmmd-guided percuta”eous trrmsthoracic core biopsy with P large-bore TN-Cut needle. Fifty-five Nm~rs were in the mediastinum. snd 122 tumors were located at subpleural area, and 42 tumors were within the lungs. In 122 subpleuml Nmors, the sensitivity of ulbrsound-guided core. biopsy for the diagnosis of malignancy was %.8%, and accuracy was 97.5%. Sensitivity for the diagxaisofrmli~ttumorslcatedwithinthelungswas94.6%,~d accuracy was 95.2%. IO 54 patients with mdiastbul twmrs, definite histologic diag”asis could be obtained in 48 patimts (88.9%). The scasitivity of ultrasmmd-guided biopsy for thediagnosis of malignancy inthese48~iPPtinnltumorswo997.1%,withPnpccurpcyof97.9%. Three patienta had complications with mini& pneumothorax and one with mild hemoptysis. We conclude that percutaneous trwthoracic core biopsy with Tm- Cut needleunder ultrasamd guidPlrce is a safe and sensitive way to obtain sp&neas for accurate histologic diagnosis of thoracic hmus. The diagnostic yield is high, Pnd the technique, relatively simple. epn also be wed for OutPatients.

Iletcction of bone marrow met&aes in small cell lung cancer patients: Canparison of immunologic and morphcdogic methods Reiske K, Myklebust AT, Aamdal S. Langholm R, J&&en E, Fodstad 0. Institute for Cancer Rcsrardr. Norwegian Radium Hospital, 0310 Oslo. AmJ Path01 1992;141:531-8.

A” immunocytwhemicpl method, involving four moncclonal nntibcdies(MAbs) previously selected fortheirspecitic bindiag tosnvll cell lung ca”cer (SCLC) cells i” huma” bone “mrrow, was used for detection of bone mprmw mtasez in 81 patients with diagnosed SCLC. Tbis pmcedure was compared with hvo muthe morphologic methods with regard to diagnostic efficiency amd sensitivity. Bone -w involvement was found in 26 ptieats (32%). ““e ofwhich had limited disease according to conventional clinical criteria. Eight of the positive cases were exclusively diagnosed by immunocytochendstry, whereas thehistologic a”d cytologic methods separately ideotitied hvo patientseach. 1mmunocyt”chemistryhadetectio” level oftumorcells in the mo”o”uclw cell fraction of appmxirmtely l-296, whereas no patiattswith less than 10% immunocytologically de4ectable Nmor cells were diagnosed by cytomorphologic exruninatio” of bone mprmw aspirates. Evidence was obtai”ed that the diagnostic efficiency of any method increased with the number of samples examined. Of the four MAbs used, the Mti-NCAhl sntibcdy, MOC-1, labeled Nmor cells in allimmunologicallypositivepatients, Pndinallbutoneofthesepatknts all cytologically confirmed tumor cells were tied. The antibodies MOC-31, which recog”ize P cluster-2 rmtige”, and NrLulO bound nearly all tumor cells ia most cases, whereas MLuCl only diagnosed NmOr cells in a fraction of the patients. The results show that the immuaccytochemical application of these antibodies is superior to morphologic techniques in dete&tg SCLC bone mprrow met8sta.w. FultherureofthemetbodmightprovidepmgnosticPLlyandtherapeuticnlly useful information.